Prevalence of peripheral neuropathy in Egyptian hepatitis C virus patients: correlation to some clinical and laboratory parameters

The present study was undertaken to assess prevalence and characteristics of peripheral neuropathy [PN] in Egyptian hepatitis C virus [HCV] patients. Eighty newly diagnosed HCV patients were enrolled, with 20 healthy volunteers. All were subjected to: full clinical examination, neurological examination, laboratory assessment including; routine blood tests, ESR, CRP, RF, ANA, C4, cryoglobulins [CGs], anti-GM1 antibodies, HCV antibodies, Quantitative PCR, abdominal ultrasonography, liver biopsy, and electrophysiological assessment. Thirty-six patients [45%] had clinical neuropathy, 18 patients [22.5%] had subclinical neuropathy. Thirty-eight out of the 54 PN patients [70.3%] showed axonal neuropathy which is mainly sensory affecting lower limbs. Twelve patients showed +ve cryoglobulinemia, all of them had neuropathy [10 clinical, 2 subclinical]. Abnormal titers of anti-neuronal antibodies were associated with electrophysiological abnormalities in 50 out of the 54 PN patients. PN correlated with age, disease duration, ESR, CRP, RF, HCV viraemia, CGs, anti-GM1 and hypocomplementinemia. PN exists in high prevalence among Egyptian HCV patients, and is associated with CG. It is mainly of axonal sensory type more affecting lower limbs. HCV patients should be investigated for the presence of CGs even in the absence of clinical manifestations

Assessment of lipid peroxidation and antioxidant status in rheumatoid arthritis and osteoarthritis patients

The aim of the present study was to assess the lipid peroxidation [LPO] and antioxidant status of patients with rheumatoid arthritis compared with osteoarthritis. This study included 30 RA, 30 OA patients and 15 healthy subjects. Parameters of activity of RA patients and clinical parameters of OA patients were assessed. Erythrocyte sedimentation rate [ESR], C reactive protein [CRP], serum malondialdehyde [MDA], the activities of erythrocyte superoxide dismutase [SOD] and catalase [CAT], glutathione [GSH] level, plasma glutathione-S-transferase [GST] activity and ceruloplasmin [Cp] level were measured. Increased MDA, plasma GST activity and Cp levels with reduction of the activities of SOD, CAT and GSH levels were demonstrated in RA and OA patients. A positive correlation was detected between the clinical and laboratory parameters in both RA and OA patients with GST and Cp. A direct correlation was found between previous parameters and serum MDA in RA. Meanwhile, a negative correlation was observed between these parameters with erythrocyte SOD, CAT activities and GSH level. Direct correlation also existed between MDA and GST with Cp, between erythrocyte SOD with CAT activities and negative correlations of GST activity with GSH level. Increased oxidative stress in RA and OA patients have led to compensatory changes in the levels of antioxidants. These changes provide additional protection against LPO. These findings confirm the role of oxidative stress in the pathogenesis of RA and OA, and that LPO markers and antioxidants can serve as surrogate markers for disease activity

Immunohistochemical expression of cyclooxy genase- 2 [COX - 2] and vascular endothelial growth factor [VEGF] in oral: premalignant lesions and squamous cell carcinoma

Squamous cell carcinoma [SCC] represents more than 90% of all head and neck cancers. It can arise de novo or from premalignant lesions. Seventy to ninety percent of all precancerous oral lesions have the potential to develop into malignant phenotype. Early detection and identification of the molecular changes that are responsible for tumor development and progression is of paramount importance in medical and surgical intervention with improved outcome. Angiogenesis is an essential condition for the development and proliferation of malignant tumors. Cyclooxygenase [Cox-2] as well as vascular endothelial growth factor [VEGF] are two epitopes among the different pro angiogenic molecules that have been investigated in literature in relation to tumor angiogenesis. The present study aimed at delineation of the molecular expression profile of Cox-2 and VEGF factors in oral cavity premalignant dysplatic lesions and SCC and its relation to tumor development, grade and stage of the tumor. Thirty cases were studied, which included 12 tongue lesions, 3 in the cheek and 15 in the palate and mandible. The studied cases were categorized into: five oral premalignant cases [leukoplakia] and 25 cases of invasive SCC with six cases presented by metastatic cervical lymph nodes. Paraffin embedded tissues were processed and sections were immunohistochemically stained using Avidin Biotin peroxidase complex [ABC] with Cox-2 and VEGF [Ab-7] epitopes. Positive staining for Cox-2 was detected in 3 out of 5[60%] of precancerous oral lesions, but it appeared in 9 out of 25 [36%] of SCC cases. Total positivity for Cox-2 reached 40% [12 out of the 30 samples]. As regards VEGF immuno staining, positive reaction was detected in one out of 5 cases [20%] of precancerous lesions and in 12 out of 25 cases [48%] of malignant lesions. Total positive reaction for VEGF was seen in 13 out of the 30 samples examined [43%]. Expression of VEGF was almost of the same ratio in premalignant and grade I tumors [25% and 26%] respectively, but it was increased in grade II [85%] and grade III tumors [66%]. Correlation between VEGF staining and grading of the SCC showed a significant difference [p=0.018]. An interesting finding in this study, is the expression of both Cox-2 and VEGF markers in normal fibroblasts, inflammatory cells, minor salivary glandular epithelium as well as some endothelial cells. Co-expression of both Cox-2 and VEGF staining was significantly correlated [p=0.004]. The results of this study demonstrated a definite role for Cyclo-oxygenase and VEGF as two pro-angiogenic factors that proved to be existing in both oral premalignant and SCC tumors .The dysplastic epithelium nearby a tumor area or in leukoplakia lesion expressed both markers with increased ratio for Cox-2 than VEGF factor. There was a direct relationship between VEGF immunopositivity and increased SCC grade. Also,co-expression of Cox-2 and VEGF was significantly correlated. From the present study it can be concluded that, both Cox-2 and VEGF factors are expressed in oral premalignant as well as SCC lesions, but Cox-2 may have a role in early stages of tumorigenesis, while VEGF showed a clear existence in higher grades of SCC

Association of interstitial pulmonary fibrosis and rheumatic disorders in chronic hepatitis c virus infection patients

To investigate the association of idiopathic pulmonary fibrosis [IFF] and rheumatological disorders in patients with chronic hepatitis C virus [HCV] infection via clinical laboratory and radiological studies. Fifty one patients, 36 males and 15 females, with documented HCV and 25 healthy subjects, 18 males and 7 females, were enrolled in the study. Clinical examination, laboratory investigations [biochemical, virological and immunological] and plain chest X-ray [CXR], high resolution computed tomography [HRCT] and pulmonary function tests [PFT] were performed in all subjects. The presence of arthralgia, myalgia, fibromyalgia, polymyositis [PM], type II mixed cryoglobulinaemia [MC], purpura, and Raynaud's phenomenon and pulmonary fibrosis, were observed in 8/51, 10/51, 4/51, 5/51, 9/51, 2/51, 1/51 and 9/51 of HCV-positive patients, respectively. The presence of high serum creatinine kinase [CK], RF, ANA, complement-4 [C4] reduction and Anti-Jo-1 antibodies were observed in 5/51,5/51, 2/51, 3/51 and 3/51 of HCV-positive patients, respectively. There was a significant difference between controls and patients with HCV for the presence of arthralgia, myalgia, polymyositis, type II MC and IFF on HRCT [p<0.01, <0.01, <0.05, <0.01 and <0.01 respectively]. Pulmonary fibrosis was found in 3/5 and 5/9 patients with polymyositis and type II MC respectively. HRCT findings of IFF consisted of nodular areas of high attenuation, ground-glass attenuation, consolidation, septal lines, non-septal lines, and honeycombing in 6/51, 2/51, 1/51, 2/51, 4/51, and 1/51 patients with HCV, respectively. Our nine patients with interstitial pulmonary involvement had HRCT scores consistent with mild parenchymal abnormalities in 3, moderate in 5 and severe in one patient. Only one case in the controls [1/25] had ground-glass attenuation on HRCT. PFT abnormalities were present in only 13 patients [-26%]. PFT measurements revealed that VC, FVC, FEV1, and FEF25-75 were below 80% of the predicted value in 10/51, 11/51, 8/51 and 16/51 patients with HCV, respectively. DLCO was decreased in 21/51 patients. However, there was no significant difference between controls and patients with HCV infection in mean PFT parameters. No correlation was found among HRCT features and PFT abnormalities. The results of this study suggest that chronic HCV infection appears to be involved in the pathogenesis of rheumatic diseases and pulmonary fibrosis. An association between interstitial lung disease [ILD] and polymyositis and/or type II mixed cryoglobulinemia seems to occur frequently in patients with chronic HCV infection. HRCT provides a sensitive and noninvasive technique than PFTs for detecting pulmonary involvement in HCV despite absence of symptoms, normal chest radiograph, and normal pulmonary function testing

Serum high sensitivity c-reactive protein as an approach to assess disease activity in hand osteoarthritis

Objective: To measure serum level of high sensitivity C-reactive protein [hs CRP] in patients with hand osteoarthritis [OA] and to correlate this level with the activity of the disease as detected by bone scintigraphy of both hands

Methodology: The study included 59 patients with hand OA, J6 non erosive OA [non EOA] and 23 erosive OA [EOA]. All patients were subjected to full medical history taking, thorough general clinical examination and clinical examination of hand joints, plain x-ray and bone scintigraphy of both hands. Serum level of hs CRP was measured by particle enhanced immunoturbidimetric method

Results: Serum level of hs CRP was significantly higher in patients with EOA [6. 74 +/- 0.52 mg/L] than in non EOA patients [5.38 +/- 0.58 mg/L]. There was a statistically highly significant difference between both groups as regards the number of scintigraphically positive joints. There was also a significant correlation between hs CRP and the number of clinically affected joints within each group. The correlation between hs CRP and scintigraphically affected joint count was highly significant in EOA patients only. The radiological joint count did not correlate with hs CRP in either group

Conclusion: Higher serum level of hs CRP in EOA may indicate the presence of an inflammatory element in this type of OA. The positive correlation between the level of hs CRP and the count of scintigraphically affected hand joints in EOA demonstrates that it can be used as a feasible test to assess disease activity

Assessment of fatigue in ankylosing spondylitis patients: clinical and self-reported measures

Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis [AS]. However, fatigue has been reported as the major complaint of AS patients. To evaluate fatigue as a potential independent domain in comparison to the conventional ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug [NSAID] therapy. Twenty patients were selected as having painful AS [modified New York criteria 1984]. The following variables were recorded at baseline and after six weeks of NSAID therapy: pain [VAS], function [Bath Ankylosing Spondylitis Functional Index], patient's global assessment [VAS], inflammation [night pain], morning stiffness, metrology [Schober test, finger-to-floor] and fatigue using 0-100 VAS scale. Analysis consisted of the prevalence of fatigue [VAS value of at least 50mm] and the sensitivity to change, by calculating the standardized response mean [mean change / S.D. change] [SRM] between before and after NSAID therapy. Fatigue was considered important in 14 patients [out of 20: 70%]. The information provided by pain, function and global assessment explained only 44% of the variability of the variable "fatigue" [similar analyses considering "pain" on the one hand and "function" on the other hand as the dependent variables showed an R value of 34 and 60%, respectively]. The NSAID treatment effect [SRM] was higher for the variables "pain" and "function" [0.76 and 0.71 respectively] than for "fatigue" [0.34]. This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on fatigue than on pain or functional impairment

Evaluation of CD[7] T-cell deletion marker for diagnosis of mycosis fungoides

Clinical diagnosis of mycosis fungoides [MF] in its early stages can be difficult and requires biopsy confirmation of disease. Even with histological evaluation, early-stage MF is still difficult to distinguish from various benign inflammatory dermatoses [BID]. Recent attempts to enhance the diagnostic sensitivity and specificity have mainly focused on lymphocyte Immunophenotyping and genotyping [1, 2]. Our purposes in this study were clinical and histopathologic assessment of MF patients in addition to evaluate the diagnostic value of Immunophenotyping with special reference to CD7 deletion. The study was carried on 19 MF patients and 16 cases of BID as a control group. They were subjected to full clinical examination, routine laboratory investigations and chest x- ray. Skin biopsies were obtained from all MF cases and BID control group. The paraffin embedded skin specimens were stained with hematoxylin-eosin stain [H and E] and immunostains for CD3, CD4, CD8 and CD7. According to Smoller's [3] histological criteria, the diagnosis of MF was confirmed; showing various pathologic patterns including granulomatous MF in one case. Immunophenotyping results revealed that T-cells in all MF and BID specimens were predominantly expressed CD3+, CD4+ and negatively stained by CD8. Conversely, the mean CD7+ count as a percentage of total T-cells in MF specimens [16.8%] was significantly lower than those of BID [61.7%]. The sensitivity and specificity of CD7 deletion [expressed by <50% of T-cells] for diagnosis of MF was 89.5% and 93.75% respectively. CD4/CD8 ratios greater than 2:1 and 10:1 were noticed in 73.7% and 31.3% of MF biopsies. CD4/CD8 ratios more than 10:1 were specific for MF while ratios greater than 2:1 were also found in 15.8% of BID. We can conclude that MF may manifest a variety of histological forms. Expressions of conventional T-cell markers including CD3, CD4 and CD8- do not generally distinguish benign T-cell infiltrate from MF, however, deletion of CD7 [<50%] has demonstrated considerable usefulness in the diagnosis of MF [89.5%] and was occasionally found in BID [6.25%]

Evidence of cerebral hypoperfusion with [99m]tc HMPAO SPECT in Egyptian scleroderma patients

The aim of this study was to investigate regional cerebral blood flow [rCBF] with 99mTc-hexamethyl-propylenamine oxine [HMPAO] single photon emission computed tomography [SPECT] in a group of 22 patients affected with systemic sclerosis [SSc]. The SPECT findings were correlated with clinical data and MRI whenever possible. The study was conducted on 22 Egyptian SSc patients in comparison to ten healthy age-matched controls. Subjects affected with concomitant diseases that might interfere with the interpretation of the SPECT results were excluded. SPECT findings were correlated with clinical data, magnetic resonance imaging [MRI] of the brain and magnetic resonance angiography if available. Twelve SSc patients [54.5%] showed cerebral hypoperfusion, focal in 8 [66.7%] patients and diffuse hypoperfusion in 4 [33.3%] patients at the SPECT analysis. MRI was available in 15 patients and was shown to be altered in five of them [33.3%]. Magnetic resonance angiography [MRA] was normal in those five patients except one. No significant differences were found between the group of SSc patients showing hypoperfusion and those showing a normal SPECT scan regarding age, the duration of disease and damage of other organs typically involved in the disease. Focal or diffuse cerebral hypoperfusion was found with SPECT in more than half of the neurologically asymptomatic SSc patients. SPECT was more sensitive in reflecting changes of cerebral blood flow than MRI. The hypoperfusion was not linked to ageing and possibly reflects the cerebral location of the microangiopathic process characterizing the disease