Evaluation of serum interleukin-6 level as a screening/diagnostic marker for patients with nasopharyngeal carcinoma: a comparative study versus Epstein - Barr virus plasma load estimation

The present study was designed to evaluate serum levels of interleukin-6 [IL-6] in pre-treatment samples obtained from patients with biopsy confirmed nasopharyngeal carcinoma [NPC] and to correlate it with Epstein-Barr [EBV] DNA plasma load estimated using quantitative PCR, tumor clinical staging and pathological grading so as to determine its applicability as a screening and/or diagnostic marker for NPC. The study comprised 30 patients had biopsy confirmed NPC and 10 healthy volunteers as control for estimated serum IL-6. Patients were subjected to full history taking, complete clinical examination, nasopharyngoscopy and imaging studies. Blood samples were collected prior to and after completion of chemo-radiotherapy course for qualitative identification and quantitative estimation of EBV DNA plasma load and, estimation of serum IL-6. Ten patients were clinically staged II, 12 patients had stage III lesions and 8 patients had stage IV lesions. Histopathologically, 14 specimens were of WHO type 1, 10 specimens of WHO type 2 and 6 specimens WHO type 3. Qualitative PCR could detect EPV-DNA, in all blood samples and mean pre-treatment EBV DNA plasma load was 2126.2 +/- 665; range: 1098-3248 copies/ml. The mean pre-treatment serum IL-6 was 175.6 +/- 32.8; range: 128-235 ng/ml and was significantly higher than control levels. Mean serum IL-6 was significantly higher in patients clinically staged IV compared to those staged II and III and was significantly higher in patients with lesions type 3 compared to those with lesions type 1 and 2. Mean EBV DNA plasma load was significantly higher in patients staged IV compared to those staged II and III but showed non-significant difference between pathological types. There was a positive significant correlation between estimated serum IL-6 levels and EBV DNA plasma load, [r=0.428, p=0.018], TNM clinical staging of the lesion, [r=0.432, p=0.017] and WHO pathological type, [r=0.513, p=0.004] and between estimated EBV DNA plasma load and TNM clinical staging of the lesion, [r=0.604, p=0.026], but the correlation was non-significant [r=0.344, p>0.05] with WHO pathological type. Evaluation of the specificity of both serum IL-6 and EBV DNA load as a predictor for pathological grade using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] revealed a non-significant difference in the specificity of both parameters for prediction of pathological grade of lesion. Post-treatment mean serum level of IL-6 and EBV DNA plasma load were significantly lower compared to pre-treatment level. In conclusion, estimation of serum IL-6 could be used as a screening test for detection of cases of NPC among suspicious patients and as a diagnostic test for cases with established NPC

Resveratrol ameliorates experimentally-induced gentamicin nephrotoxicity: a biochemical and histological evaluation in rats

This experimental study aimed to investigate the possible effect of resveratrol [RSV], an antioxidant agent, during Gentamicin [GEN] treatment as a prophylactic modality against drug induced renal tubular affection. The study comprised 30 normal rats divided into 3 equal groups: Control group: Did not receive medications, GEN Group: Received IP injection of GEN [80mg/kg/day for 6 days] and RSV+GEN Group: Received IP injection of GEN [80mg/kg/day] and RSV [10mg/ kg/day for 6 days]. At the 6th day, blood samples were withdrawn for estimation of serum creatinine, urea and Na and K ions, then all animals were sacrificed and both kidneys were immediately removed and a renal cortex biopsy was obtained for estimation of renal tissue extract activity of glutathione [GSH], glutathione-S-transferase [GST], superoxide dismutase [SOD] and catalase [CAT] and tissue content of non-protein sulphydryl [NPSH] and lipid peroxides. Both kidneys were dissected out for histological studies and scored for seventy of tubular changes. In comparison to control group; GEN caused a significant elevation [p[1]<0.001] of serum urea and creatinifte associated with increased serum Na+ and decreased K+ levels with significantly increased levels of SOD, MDA and NPSH levels and decreased levels of GSH, GST and CAT in renal tissue extract. On contrary, RSV injection in combination with GEN significantly ameliorated the effects imposed by GEN on the oxidant/antioxidant equilibrium manifested as a non-significant increase of tissue extract levels of MDA and NPSH associated with non-significant decrease of tissue extract level of GSH and GST in GEN+RS V group compared to control group [p[1]>0.05] but tissue extract levels of SOD and CAT were significantly increased [p[1]=0.016 and 0.005, respectively] compared to control group. RSV lessened the nephrotoxic effect of Gentamicin in combination group with a significant decrease of serum urea and creatinine levels compared to that estimated in GEN group, [p[2]=0.008] with a significantly decreased serum Na+ and increased serum K+ compared to levels estimated in GEN group [p[2]=0.007 and =0.008, respectively]. Light microscopic examination of renal tissue obtained from rats injected with GEN for 6 days, showed degenerative changes with necrosis of proximal tubular cells and contracted glomeuli associated with tubular and glomerular vacuolation. There was tissue edema and intense inflammatory cellular infiltrates. Semi-quantitative analysis of tubular necrosis, tubular vacuolization and parietal cell hyperplasia in animals treated by GEN and GEN+RSV showed a significant reduction of scores of each parameter in GEN+RSV group compared to GEN group with no necrosis reported in 55.6% and no parietal cell hyperplasia in 33.3% of animals included in GEN+RSV group, while all GEN treated animals showed tubular necrosis and vacuolation with parietal cell hyperplasia of varied scores. It could be concluded that concomitant administration of resveratrol during Gentamicin therapy in high dose and for long period could ameliorate the structural changes and preserve the oxidant/antioxidant balance in renal tissue with minimization of affection of renal function tests

Anesthesia for laparoscopic cholecystectomy in cirrhotic patients: a comparison of sevoflurane versus isoflurane

This study aimed to compare the effect of anesthesia using isoflurane [ISO] or sevoflurane [SEVO] in conjunction with nitrous oxide on postoperative liver function tests in 30 cirrhotic patients [Child-Pugh Grade A] assigned to undergo laparoscopic cholecystectomy [LC]. Anesthesia was maintained with either sevoflurane [SEVO group] or isoflurane [ISO group] with nitrous oxide 3 L/min in oxygen 3 L/min. Non-invasive intraoperative monitoring included heart rate [HR], systolic and diastolic blood pressure [SBP and DBF] estimated before induction of anesthesia [T[1]], 5 min. after insufflation [T[2]], 5-min after tilting in reverse Trendlenburg position [T[3]] and after exsufflation of CO2 [T[4]]. Venous blood samples were taken for estimation of serum levels of aspartate [AST] and alanine [ALT] aminotransferases, total bilirubin [TB] and alkaline phosphatase [AP] before and I, 3, and 7 days after surgery. Another venous blood samples were taken at time of induction of anesthesia, at, 2-hrs and 24-hrs after the end of surgery for estimation of serum levels of a-glutathione S-transferase [GST]. The formation of the lidocaine metabolite monoethylglycinexylidide [MEGX Test] was estimated preoperatively and immediately postoperative. All patients developed significantly higher HR, SBP and DBF at T[2] and T[3] compared to at T[1] with a significantly higher measures at T[3] compared to at T[2], but measures recorded at T[4] were significantly lower compared to that recorded at T[2] and T[3] in both groups with a significantly lower blood pressure in ISO group and non-significantly lower blood pressure measures in SEVO group compared to measures recorded at T[1]. Postoperative serum AST and ALT levels were significantly higher compared to preoperative levels in both groups reaching a peak at 3-days PO and declined on the 7[th] PO day with significantly higher levels in ISO group compared to SEVO group at 3-day and 7-day PO. Serum GST levels estimated at and 2-hrs after end of surgery were significantly higher in both groups compared to levels estimated at time of induction of anesthesia with significantly higher levels at 2-hrs compared to levels estimated at end of surgery in both groups, but was significantly higher in ISO group compared to SEVO group. Postoperative serum MEGX levels were significantly lower in both groups compared to levels estimated at time of induction of anesthesia with a nonsignificant difference between both ISO and SEVO group. It could be concluded that LC in cirrhotic patients performed under sevoflurane anesthesia supplemented by NO[2] is a feasible safe procedure with less postoperative impairment of liver function tests in comparison to isoflurane anesthesia and serum GST and MEGX are useful early biomarkerfor liver dysfunction that precede enzymes alteration in cirrhotic patients undergoing LC