Persistent oxidative stress in patients with chronic active hepatitis-C infection after antiviral therapy Failure

Oxidative stress and hepatocellular pathological changes are common associations with chronic hepatitis C virus [CHC] disease. The aim of this study was to assess serum antioxidant-oxidant [Redox] balance in patients with CHC infection before and after intake of the traditional antiviral therapy [pegylated interferon alpha-2b and oral ribavirin]. Blood samples from 50 biopsy-proven CHC patients, with no prior anti-viral treatment and persistently elevated serum transaminase levels for 6 months, as well as 15 age- and sex-matched healthy subjects were used for determination of the antioxidants: reduced glutathione [GSH], superoxide dismutase [SOD], alpha tocopherol and ascorbic acid as well as lipid peroxidation [LPO] index [malondialdehyde [MDA]]. The measurements were repeated in the diseased group 25 weeks after pegylated interferon alpha-2b and ribavirin combination therapy. Serum levels of bilirubin, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly higher in CHC patients than in the control group [P < 0.05]. Pretreatment serum MDA values were significantly higher in patients with CHC infection than the control group [P < 0.001], while serum antioxidant levels were significantly lower [P < 0.001]. Responders [10 patients] had lower pretreatment serum levels of MDA than non-responders [35 patients] [P < 0.001]. Both groups were comparable for the antioxidant serum levels. There was significant negative correlation between serum MDA and serum SOD, GSH, alpha tocopherol, and ascorbic acid concentrations in CHC patients. On the other hand, there was no correlation between the studied parameters and serum bilirubin, albumin, ALT, and AST. Redox imbalance was detected in patients with CHC. Responders had significantly lower levels of MDA than non-responders. Serum MDA may be used as a pretreatment predictor of response to antiviral treatment in patients with CHC

Correlation between subclinical common carotid artery atherosclerosis and plasma homocysteine level in rheumatoid arthritis

Objective: To detect subclinical morphologic atherosclerotic changes of common carotid artery in rheumatoid arthritis patients and to correlate it with plasma level of homocysteine, C-reactive protein and disease severity

Methodology: The study included twenty five rheumatoid arthritis females as a patient group, their age ranged from 42 to 66 years. Their disease duration was more than 5 years. Nine apparently healthy females served as a control group, their age ranged from 42 to 65 years. All patients and controls were chosen with exclusion criteria including: presence of hypertension, diabetes mellitus, renal insufficiency, history of any cardiovascular or cerebrovascular events, hyperlipidemia, using lipid lowering agents, smoking and intake of contraceptive pills. Patients were subjected to full history taking, thorough clinical examination, disease severity assessment using disease severity index, disease activity assessment using the modified disease activity score [DAS], physical activity assessment using Stanford Health Assessment Questionnaire [HAQ], laboratory investigations especially C-reactive protein and serum homocysteine level. Intima media thickness of the right common carotid artery and plaques were detected with B-mode ultrasound

Results: Seventeen patients [68%] out of 25 had increased intima media thickness of right common carotid artery [subclinical atherosclerosis]. Among them 6 showed atherosclerotic plaques and I 1 without atherosclerotic plaques. Intima media thickness and homocysteine level were significantly higher in patients as compared to controls. Age, disease duration, severity index, C-reactive protein, homocysteine level and intima media thickness were significantly increased in patients with sabclinical atherosclerosis as compared to those without atherosclerosis. Intima media thickness showed a significant positive correlation with age, disease duration, severity index, C-reactive protein and level of homocysteine

Conclusion: Our results suggest the presence of subclinical atherosclerosis in rheumatoid arthritis patients as indicated by increased intima media thickness of common carotid artery. Chronic inflammation may play an important role in development of this atherosclerosis. We also suggest that increased homocysteine level may be a non traditional risk factor for atherosclerosis in rheumatoid arthritis. B-mode ultrasound can be considered a useful tool for detection of early morphologic atheroscleroric changes in carotid artery despite absence of clinical manifestations for this atherosclerosis

Correlation between functional and electrophysiological recovery following repair of complete median and ulnar nerve lacerations at the wrist in adults

Objective: To perform a comparative study between functional and electrophysiological recovery following repair of complete median and ulnar nerve injuries at the wrist in adults, and to assess to what extent they can provide a prognosis for recovery and in decision making in further treatment interventions during the regeneration stage

Methodology: This prospective follow-up study was conducted on 40 patients with complete median and ulnar nerve injuries. The functional assessment and electrodiagnostic evaluation tests were performed every three months for 18 months follow up period post-operatively, with the first baseline test was performed within four weeks of the injury. Assessment was performed according to standardized tests procedures and numerical scoring for documentation of outcome after nerve repair

Results: Our study results revealed better acceptable motor functional recovery in 85% of all study population when compared with only 65% of cases who achieved acceptable recovery of sensibility. The ulnar nerve tended to achieve clinically poorer sensory and motor function outcome. In 70% of cases, the functional motor score was equivalent to the functional sensory recovery score with a moderate strength of agreement with each other. On comparing the functional and electrophysiological outcome data, we found that there was 52.5% of cases showed identical scores for all three outcome measures with a fair strength of agreement between these variables. Poor agreement between functional sensory and sensory electrophysiological recovery scores were demonstrated in most [57.5%] of our patients, and this could be expected from the poor obtained sensory electrophysiological findings demonstrated in 23 cases of patient population. 0n assessing the reinnervation 0f the small intrinsic muscles, we found a substantial agreement and statistically significant difference between electrophysiological and motor functional recovery scores. We also discovered that for the ‘good ’ and ‘moderate ’ functional motor recovery cases, improvement was detected first with electrodiagnosis

Conclusion: From the study, we can report that sensory electrophysiological scores are inadequate predictors of functional sensory recovery. Our study also demonstrated a substantial agreement between the fictional motor and electrophysiological recovery scores, and the regeneration of the intrinsic muscles was detected earlier by electrophysiological testing than by functional clinical assessment methods. So, electrophysiological evaluation tests may add valuable information and considered an adjunct to the clinical assessment methods to evaluate the regeneration process earlier and in case of doubt, and help to decide on the correct treatment strategy if secondary surgical re-exploration is required