Association between HCV induced mixed cryoglobulinemia and pulmonary affection: the role of TNF-alpha in the pathogenesis of pulmonary changes

Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection

Human leukocyte antigen class I alleles can predict response to pegylated interferon/ribavirin therapy in chronic hepatitis C Egyptian patients

Racial differences and broad spectrum response to anti-hepatitis C [anti-HCV] therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen [HLA] class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon [Peg-IFN] plus ribavirin therapy in chronic hepatitis C [HCV] genotype 4 patients in Egypt. This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response [SVR] and 88 non-responders [NR]]. Serological testing of HLA class I antigens [HLA-A and HLA-B alleles] were performed by standard complement-dependent microlymphocytotoxicity assay. The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 [P = 0.011], B40 [P < 0.001] and B41 [P < 0.001] was significantly higher in NR cases [OR/95% CI: 7.05/ [1.39-18.01], 10.31/3.14-36.1. On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR [OR: 0.50; 95% CI: 0.28-0.89; P = 0.02] and HLA-B38 can predict non response to therapy [OR: 7.92; 95% CI: 1.67-37.54; P = 0.009] with an overall accuracy of 60%.Severe ??brosis [OR: 3.035; 95% CI: 1.521-6.091; P = 0.002], high viremia [OR: 2.69; 95% CI: 1.11-6.53; P = 0.005] and steatosis [OR: 2.1; 95% CI: 1.002-3.90; P = 0.041] predicted no response with an overall accuracy of 81.8%. HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection

Malunited distal radius fractures

In this prospective study, 64 malunited distal radial fractures were operated upon for the correction of the deformity and restoration of the normal anatomical relationship in the radiocarpal and distal radioulnar joint [DRUJ]. Postoperatively, the patients were involved in an intensive rehabilitation program till restoration of the maximum functional recovery. The patients were followed up for a minimum of 12 months. The final results were assessed both clinically and radiologically with correlation to the type of fracture and timing of the surgical intervention. Fifty-one patients in this series had excellent results, ten had good, three had fair, and none was rated as poor. The study revealed that thorough preoperative assessments of the plain X-rays, CT, and/or MRI and operative restoration of the normal anatomical relations are essential to achieve good results in these difficult cases

Perilunate dislocations and fracture-dislocations

Perilunate dislocations [PLD] and fracture-dislocations [PLFD] are severe wrist injuries and most difficult to manage. The initial diagnosis is missed in many instances of these serious injuries that may compromise the outcome. We present our results in the management of nineteen cases of perilunate dislocations and fracture dislocations. This study demonstrates the prognosis with the different treatment techniques showing that good results can be expected by closed reduction, with or without internal fixation. The severest injuries with multiple fractures of the carpal bones as well as neglected and missed cases for longer than four weeks from injury gave the worst prognosis. We would like to stress on the importance of early diagnosis, immediate referral to a specialised hand surgeon for the definitive management and the important role of intensive physiotherapy for these major hand injuries