Faecal calprotectin: correlation with endoscopic and histological gradings of disease activity in ulcerative colitis

Calprotectin is an abundant neutrophil protein which is extremely stable in feces. It is excreted in excess amount in feces during inflammatory bowel disease. This work aimed to study the relationship between faecal calprotectin concentrations and endscopic as well as histological gradings of disease activity in patients with ulcerative colitis [UC]. This study comprised 25 patients, who were confirmed to have UC by colonscopy and histological examination of colonic biopsies, in addition to 10 apparently healthy individuals as controls. Complete blood picture, C-reactive protein [CRP], erythrocytic sedimentation rate[ESR] and stool analysis were done for all studied individuals. In addition, faecal calprotectin was measured by using enzyme-linked immunosorbant assay [ELISA]. Colonoscopy was done for patients only and the severity of inflammation was assessed macroscopically and histologically by using the standard scoring systems. Patients were divided into patients with active UC and patients with no/low disease activity. Faecal calprotectin concentration was significantly higher in patients with UC [p<0.001] than in controls. Also, its levels were significantly higher in patients with active disease than in those with no/low activity [p<0.001]. Moreover faecal calprotectin concentrations increased significantly with the progression of both endoscopic and histological gradings of disease activity. Faecal calprotectin level was significantly higher in patients with active pancolitis than in those with left sided colitis or proctitis [p=0.003]. There was a significant positive correlation between both endoscopic as well as histological gradings of disease activity and faecal calprotectin. Also, faecal calprotectin significantly correlated with extent of the disease but there was no significant correlation with the clinical activity index, hemoglobin level, platelets count, leucocytic count, CRP and ESR. At cut-off value of 110mg/l faecal calprotectin detected active UC with a sensitivity of 93.3% and a specificity of 100% with a diagnostic accuracy of 96%. It was concluded that, faecal calprotectin level could be used as a non invasive marker of disease activity in patients with UC and it has the potential to reduce the number of invasive investigations performed in these patients

Tissue factor, prothrombin fragment 1+2 and thrombomodulin as a contributing factors for coagulation disorders in patients with chronic hepatitis C

Chronic liver disease especially cirrhosis is associated with alterations of coagulation system commonly causing bleeding as well as thromboembolic complications. The potential pathophysio-logical roles of tissue factor [TF], promromhin fragment 1+2 [PF 1+2] and thrombomodulin [TM] are unknown. Therefore this study was designed to elucidate the possible contribution of these factors in the pathogenesis of coagulation disorders in patient with chronic hepatitis C and their relation with the degree of hepatocellular dysfunction, as defined by Child-Pugh criteria, and clinical manifestations such as bleeding tendency. 35 patients with chronic HCV [10 without cirrhosis and 25 with cirrhosis] and 10 sero-negative controls were included in this study. Cirrhotic patients [25] were further categorized according to Child-Pugh criteria as having mild [Child A, no= 10], moderate [Child B, n= 8] and severe [Child C, n= 7] liver failure. Complete blood picture, liver function tests, kidney function tests, prothrombin time [PT], activated partial thromboplastin time [APTT], viral markers and abdominal ultrasonography were done for all studied individuals PF1+2, TF and TM levels were measured by an enzyme linked immunosorbent assay [EUSA]. Plasma levels of PF1+2, TF and TM were significantly elevated in cirvhotics compared to those of non cirrhotic [P< 0.001 for all] and control groups [P< 0.001 for PF1+2, TF and TM]. Plasma TM level was also significantly elevated in non cirrhotic patients compared to control group [P < 0.001]. The plasma levels of PF1+2, TF and TM showed continuous rise with the advancement of liver disease measured by Child-Pugh criteria. Plasma levels of PP1+2 was significantly higher in Child B [2.27 +/- 0.72 nmol/L] and Child C patients [4.28 +/- 1.43 nmol/L] than those in Child A [1.14 +0.437 nmol/L] and non cirrhotic patients [0.99 +/- 0.36 nmol/L]. The same pattern was observed for TF [non cirrhotics 110 +/- 62.7, Child A 138.02 +/- 64.02, Child B 213 +/- 78.54 and Child C 317 +/- 54.75 pg/ml]. While TM levels were significantly elevated in child A, B and C [7.17 +/- 1.79 ng/ml, 11.4 +/- 2.19 ng/ml and 14.6 +/- 1.46 ng/ml] compared to non cirrhotic patients [5.4 +1.7 ng/ml]. Each of plasma PF1+2, TF and TM had a significant positive correlation with PT and APTT but they had a significant negative correlation with serum albumin while there was no significant correlation with liver enzymes and serum bilirubin. TM was significantly elevated, white PF1+2 and TF did not differ, in patients with bleeding tendency compared with those without [10.8 +/- 3.79 ng/ml vs 7.34 +/- 3.39 ng/ml]. It was concluded that patients with chronic hepatitis C especially cirrtotics have elevated levels of PF1+2, TP and TM and their levels were associated with the degree of hepatocellular dysfunction. Also, the elevated levels of TM may, at least in part, contribute to bleeding tendency. Therefore, long term follow up of patients with chronic hepatitis C who have elevated plasma PF1+2, TF and TM levels is required to assess their clinical importance