Insulin resistance and liver fibrosis progression in patients with chronic hepatitis C virus infection

Hepatitis C virus [HCV] infection can predispose to development of insulin resistance before diabetes occurs. Such a potential link is particularly cogent in light of recent date indicating that diabetes might be associated with increased hepatic fibrosis progression in patients with chronic HCB infection. This study aims to determine the prevalence of insulin resistance in non-diabetic patients with chronic hepatitis C and its relation to liver fibrosis. This study included a cohort of 38 patients with chronic liver diseases. They were subdivided into two groups: chronic hepatitis C [CHC] with elevated liver enzymes and CHC with normal liver enzymes. Twelve age- and sex-matched healthy subjects were considered as the control group. The cohort was subjected to careful history and complete examination stressing upon the signs and symptoms of chronic liver diseases. Investigations include liver function test, viral markers [anti-HCV antibodies and polymerase chain reaction [PCR] for HCV], serum fasting glucose, serum fasting insulin and homeostasis model assessment [HOMA], liver biopsy and abdominal ultrasound. Liver fibrosis was found to be considerably more severe among HCV patients elevated serum transaminases levels. No correlation between viral load and hepatic fibrosis in HCB-infected patients was found. Insulin resistance was present in HCV-infected cases compared with the control group and it correlated with liver fibrosis positively. The present data support the hypothesis that insulin resistance may increase the rate of fibrosis progression in non-diabetic patients with chronic HCV. Follow-up of hyperinsulinaemia by serial measurements of HOMA test in non-diabetic HCV-infected patients may be a biochemical indicator for progression of liver fibrosis

Three-dimensional characterization of epiretinal membrane using spectral domain optical coherence tomography

To describe epiretinal membrane [ERM] features using spectral domain optical coherence tomography [SD OCT] and to delineate the three-dimensional [3D] relationship in eyes with epiretinal membrane. Fifty-two eyes of 44 patients with ERM were classified into two groups: idiopathic ERM and secondary ERM. Posterior vitreous face was evaluated. Pattern of ERM attachment was divided into: focal and global. A 3D SD OCT system [5 micro m resolution] was used for scanning. Surface maps were used to study retinal topography. Surface maps revealed manner and direction of epiretinal traction, pattern of attachment and blood vessel involvement. In 55.8% of eyes the membrane was globally adherent to the retina. There was a significant association [p = 0.02%] between pattern of membrane

Spontaneous bacterial peritonitis: clinico-epidemiological and microbiological study

Spontaneous bacterial peritonitis [SBP] is a frequent severe and potentially life-threatening complication of cirrhotic patients with ascites. The clinical presentation of SBP depends on the stage at which the infection is diagnosed. In early stages, most patients are asymptomatic or present with insidious, non specific symptoms. As the disease progresses, patients show signs and symptoms of peritoneal infection. To determine the prevalent pathogens responsible for SBP in our locality and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Two hundred fifteen adults with cirrhotic ascites consecutively admitted to Tropical Medicine Unit Mansoura University Hospital were screened for SBP. One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Diagnosis of cirrhosis was based on clinical biochemical radiological and/or histo-pathological data. Ascitic fluid was subjected to cytological biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Diagnosis of SBP and its variants were made depending on ascitic fluid poly-morphnuclear count >/= 250 cell/ mm[3] and/or monomicrobial growth in ascitic fluid culture without evidence of an infra-abdominal surgically treatable source of infection, and no recent use of antibiotics. A total of 432 diagnostic paracentesis were performed in 215 cirrhotic patients with ascites. The prevalence of SBP was 25.02%. History of previous episode of SBP or history of paracentesis were significantly more frequent in SBP patients [P=0.000 and P=0.001] respectively also, Abdominal wall edema and redness [cellulitis], presence of ascetic fluid with numerous fine internal hyper-echoic particulates by ultrasonography and the aspiration of slightly turbid ascites were significantly more frequent in SBP patients [P= 0.01, P=0.031 and P=0.035] respectively. Ascitic fluid protein levels and serum albumin levels were significantly lower and serum creatinine levels were significantly higher in SBP patients. [P=0.009, P=0.03, and P= 0.003] respectively. Applying the model of logistic regression analysis between SBP and Non SBP clinical and laboratory data revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were significant predictors of SBP [P-0.000]. Fourty-nine [45.37%] episodes of SBP were detected by the conventional culture compared to 79 [73.15%] by modified technique with a significant P value <0.001. Gram-negative bacteria were the cause of SBP in 46 [58.23%] culture positive episodes while Gram-positive bacteria were the isolated organisms in 33 cases [41.77%]. Escherichia coli and Staphylococcus aureus were the most commonly detected organisms in 40 [50.63%] and 26 [32.91%] cases respectively. In this study, 31.65% of cultures were highly sensitive to Levofloxacin, 29.11% were sensitive to Cefotaxime, 20.25% were sensitive to Amoxicillin-Clavulanic acid, 18.99% were sensitive to Meropenem, 17.72% were sensitive to Ciprofloxacin and 15.19% were sensitive to Ceftazidime. On the other hand, antibiotic resistant rates to Ciprofloxacin were 25.32%, 24.05% to Ceftazidime and 21.52% to Cefotaxime. Previous SBP episode, low ascetic fluid protein levels, high serum creatinine, and low serum albumin levels, all had a significant prediction of SBP. Beside cytological and biochemical examination, culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP detection and must be a routine in every hospitalized patient with cirrhotic ascites. Gram-negative organisms still, the prevalent microorganisms causing SBP but there is a significant recent increase in Gram-posittue pathogen with emergence of maltidrug resistance especially for Ciprofloxacin, Ceftazidime and Cefotaxime. These recent changes may have an impact on guidelines for management and treatment of SBP in oar locality

Hepatitis C virus Infection and Diabetic microvascular complications

The microvascular complications are the important cause of mortality and morbidity of either type 1 or 2 DM. Great efforts have been made to recognize the possible susceptibility or etiologic factors of these complications; whether genetic or environmental. Hepatitis C virus infection is another prevalent problem in our community. The present work aimed to study the possible impact, if any of HCV infection on microvascular complications. A total 70 diabetic patients 17 type 1 and 53 type 2, were included [20 males and 50 females] with age ranging from 13 to 72 years and 30 healthy volunteers with matched age and sex were taken as a control group. Complete history taking and full clinical examination were done. Laboratory work up was done for patients and control including urinalysis, blood sugar, serum creatinine, urinary albumin excretion, lipogram, liver function tests, HbAlc and HCV antibodies. Fundus examination was done for patients and control. Diabetics were found to have a prevalence rate of HCV infection of 32%. Prevalence of microvascular complication, nephropathy, retinopathy and neuropathy were found to be relatively higher in diabetics with HCV infection. Advanced grades of microvascular complication were more prevalent in HCV-positive diabetics. It was concluded that HCV infection is possibly a potential aggravating factor for microvascualr complications

Comparison of Nitroglycerine- and prostaglandin E1 -induced controlled hypotension for functional endoscopic sinus surgery [FESS]

Induced hypotension is often used in surgery to reduce blood loss and to provide a relatively bloodless surgical field to facilitate surgery and to reduce operative time. The purpose of this study was to compare the intraoperative bleeding and quality of the surgical field for FESS, using controlled hypotension induced with either nitroglycerine or prostaglandin E1.Patients and methods: Thirty patients [ASA I - II] scheduled for FESS were enrolled in the study. Patients were randomly allocated into three groups where normotensive group [C] received saline infusion, nitroglycerine hypotensive group [NTG]: received NTG infusion at a rate of [0.5-5 micro g/kg/min] and, prostaglandin hypotensive group [PGEI]: received PGE1 infusion at a rate of [0.04-0.08 micro g/kg/min]. The same surgeon used a categorical scale score[0-S] to assess surgical field condition. Heart rate and invasive mean arterial blood pressure, peripheral oxygen saturation and end- tidal carbon dioxide were monitored intraoperatively. there was statistically significant decrease of blood loss in both PGE1 and NTG groups as compared to group C. Moreover there was statistically significant decrease of blood loss in PGE1 group as compared to NTG group. Intraoperative heart rate of NTG group displayed significant increased when compared to basal value of the same group, C group and PGE1 groups values. Both PGE1 and NTG groups showed significantly reduced MAP than C group except one value in NTG group where it significantly increased at 30 min, Induced hypotension with PGE1 infusion is interesting in providing consistent and sustained controlled hypotension with hemodynamic stability as well as it is effective in providing dry surgical field during FESS under general anaesthesia when compared with NTG

Contaminants in trems of pesticide residues in selected fish sources

This work aimed to assess the selected fish species with respect to their content of pesticide residues. The investigated fish included Caranx, Red mullet, crabs, clams, Sole of Qaroun Lake, Sole of Bardawil Lagoon and catfish. The results indicated the presence of 15 components of organochlorine pesticides; namely, alpha-benzene hexachloride [alpha-BHC], gamma-benzene hexachloride + beta-benzene hexachloride [gamma-BHC + beta-BHC], heptachlor, aldrin, heptachlorepoxide, gamma-chlordane, alpha-chlordane, 1,1-dichloro-2,2-bis [P-chlorophenyl] ethylene [P, P-DDE], dieldrin, endrin, 1,1-dichloro-2,2-bis [P-chlorophenyl] ethane [P,P-DDD], 1,1,1-trichloro-2,2-bis [P-chlorophenyl] ethane [P,P-DDT], endosulfan sulfate, methoxychlor and endrin ketone. The concentrations of chlorinated hydrocarbons in tissues serve as good indicators of environmental loads. The determination of organochlorine residues became necessary, since in high-polluted regions, the polychlorinated biphenyls [PCBs] are point of discussion. With respect to fish samples [Sole] collected from Bardawil Lagoon, the obtained results indicated that none of the identified pesticides were detected. Subsequently, it could be stated that Bardawil Lagoon is the best source of fish and is considered to be completely free from pollutants. On the contrary, Sole of Qaroun Lake contains six types of pesticides and the lowest frequently detected one was 8.49 mug/kg as heptachlor, while the highest concentration of methoxychlor was 1268.68 mug/kg in the same sample. The residual concentration of the aforementioned pesticides varied within the tested fish and Sole of Bardawil Lagoon proved to be completely free from any residual amounts of the investigated pesticides as indicated and proved by the statistical analysis through the principal component and factorial analysis

Nematode and water pollution in Eastern part of Nile Delta

The examination of some represented water sites revealed the presence of larvae and eggs of the nematodes infecting man and animals. Eggs in a descending order of abundance were Trichostrongylus, Toxocara canis, T. Vitulorum and Ascaris sp., then Trichocephalus and Ancylostoma sp. Larvae in a descending order were Strongyloides, Trichostrongylus and Ancylostoma sp. Contaminated or polluted water plays an important role as nematode-borne source

Cellular immune response in Giardiasis

In this study, adult persons attending the outpatients clinics of Tropical Medicine in Mansoura University, Banha Branch, Zagazig University as well as in the Clinical Pathology of Ain-Shams Specialized Hospitals were subjected to stool examination using Kato thick smear and repeated concentration technique. There was a statistically significant difference between all groups of giardiasis patients regarding the grade of CD4 lymphocyte infiltration, being more marked in the symptomatic group. The prevalence of flatulence, anorexia and vomiting was more frequent in patients with heavy CD4 lymphocyte infiltration in duodenum. A high statistical significant increase was observed in the mean OD values of anti-giardia duodenal secretory IgA in patients with marked CD4 infiltration in duodenum. But, a statistical insignificant difference was found in the mean OD values of anti-giardia total serum Ig in patients with different grades of CD4 infiltration in the symptomatic group. There was a statistically significant increase in the mean OD values of anti- giardia total serum Ig in patients with marked intraepithelial CD8 lymphocyte infiltration in the duodenum in the asymptomatic group. There was a statistically insignificant difference in the mean OD values of anti-giardia total serum Ig in patients with different grades of intraepithelial CD8 infiltration in the symptomatic group. Also, there was statistically significant increase in the mean OD values of anti-giardia total serum Ig in patients with marked intraepithelial CD8 lymphocyte infiltration in the duodenum regarding the immunohistochemical staining of giardia antigen in duodenal biopsies

Circulating nitric oxide [NO] in acute attacks of bronchial asthma

Thirty patients with bronchial asthma were included in this study. The airway reversibility in pulmonary function tests including forced vital capacity [FVC], forced expiratory volume in the first second [FEV1] and peak expiratory flow rate [PEFR] was more than 15% after the use of salbutamol inhaler. Venous blood levels of total nitrous oxide metabolites as serum nitrite and nitrate during and in-between acute asthmatic attacks were measured. ABGs were measured during and in-between asthmatic attacks. From the results obtained, it was concluded that the circulating nitric oxide level is suppressed in acute attacks of bronchial asthma, this is promptly reversible with the relief of the acute attacks

Thyroid nodule in Egyptian children, a 10 years experience

The study was done at Al-Azhar University hospitals, health insurance, and some private hospitals in the period from 1990 to 2000. A total number of 141 children, presenting with thyroid nodule were the materials of this study. 112 females and 29 were males. Their age ranged from 5 to 18 years. The thyroid hormonal profile was toxic in 16[11.3%] cases, and authyroid in 125 cases. After thyroid ultrasonography, sintigraphy. fine needle aspiration and cytological examination, surgical excision of the nodule was done, either by enucleation, lobectomy, or total thyroidectomy. The results showed that 100 [70.9%] child has solitary thyroid cold nodule, while in 25 [17.3] cases a dominant nodule was part of multinodular goiter. Histo-pathological examination revealed that malignancy was detected in 34[27.2%] of cold nodules, while adenoma was the commonest lesion 68 [54.4%]. Simple nodule, cyst, and thyroiditis, were detected in 23 [18.4%]. The malignant nodules, were 25/34 [73.5%] papillary carcinoma, and 9/34 [26.5%] follicular carcinoma. Modified radical neck dissection [lymphadenectomy] was done in three children only, where metastatic lymph nodes were excised. The highest incidence of thyroid nodules was detected between I992 and 1995. Fine needle aspiration was done in 86 cases and the results were correlated with the final postoperative histopathology. Non neoplastic Lesions were detected in 56/86 [65.1%] cases. Papillary carcinoma was detected in 11/86 [12.8%], however follicular neoplasm was found in 12/86 [14%]. Atypical cytology was gained in 7/ 86[8.1%]. Histopathological study of the fine needle aspirate in 86 cases revealed adenoma in 32/86 [37.2%], simple nodule in 17/86 [19.8%], papillary carcinoma in 18/86 [20.9%], follicular lesion in 12/86 [13.9%]. Comparing these results with the final post-operative histopathology revealed a diagnostic sensitivity and specificity near 100%. The over all diagnostic accuracy was 94.5% in papillary Iesions, 94. 12% in simple nodular goiter, but in follicular lesions we can not differentiate between benign and malignant lesions

Comparative study of serum nitric oxide levels in newborns of pre-eclamptic and normal mothers

Nitric oxide [NO] is a labile radical gas that plays a critical role in many vital biological processes, including the control of vascular tone, ventilation, inflammation and immunity. In pre-eclampsia, NO is usually increased in the maternal circulation which may in turn affect the infant of those women. This study is carried out to asses endothelial derived [endogenous] NO concentration in newborns of preeclamptic compared to those newborns of normal mothers. Serum NO levels were assayed in newborns of pre-eclamptic mothers [n=33] and newborns of normal mothers [n=12]. Serum NO levels were estimated colorimetrically using commercial kit of total NO based on the enzymatic conversion of nitrate to nitrite by nitrate reductase and detection of nitrite as an azo.dye product of the Griess reaction. Serum NO levels were found to be significantly lower among newborns of pre-eclamptic mothers [p<0.05] when compared to newborns of normal mothers. There is a defect in serum nitric oxide levels in infant of preeclamptic mothers which reflects the endothelial dysfunction, as well as, reduced uteroplacental perfusion

Practice of tonsillectomy among Egyptian children

This study was carried out on 1000 tonsillectomized children from E N T and pediatric departements- Al-Azhar University Hospitals. Their age ranged from 3to 15 years. They were 570 males and 430 females. The parents of children were interviewed through a previously prepared questionnaire sheets including personal data, social status, level of education, indications for tonsillectomy, frequency of the attacks of tonsillitis and the treatment given. All these children were clinically evaluated

Correlative study of oral lactose hydrogen breath test, lactase activity and intestinal morphology in Giardia lamblia infected children

Oral Lactose Hydrogen Breath Test [OLHBT], biochemical assay of lactase activity [LA] and histomorphologie examination of jejunal biopsies were done in 30 children [6-12 years old and both sexes] with abdominal pain and stools analysis showing trophozoites and cysts of Giardia Lamblia [GL] compared to 30 normal control of the same age group and sexes. The results showed that there was significantly increased incidence of hypolactasia in cases with giardiasis compared to control group [33.3% 10.0% respectively]. Also, the study showed that LA was significantly decreased in infected group compared to control group. Concerning histomorphologic changes in the form of shortening, atrophy and chronic cellular infiltration were present in 30% of cases. There was significantly increased incidence of abnormal histomorphologic lesions of the small intestinal mucosa in Giardiasis compared to control group. Lastly, in present work, upon doing matrix correlation the results showed that medium negative correlation was observed between the grade of histopathologic features of jejunal biopsies and the LA [micro t molgram/min] while medium positive correlation was noted between the grade of histopathologic features of Jejunal biopsies and maximum rise in H2 breath concentration [p.p.m] detected by OLHBT