Serum miRNA-1 as a novel biomarker for acute myocardial infarction and unstable angina

Background: Coronary artery diseases are the predominant cause of morbidity and mortality in developed and developing countries. Thus, extraordinary efforts have been directed to determine the molecular and pathological characteristics of the diseased heart in order to develop novel diagnostic and therapeutic strategies miRNAs are class of abundant, non-coding RNAs that attracted scientists' attention for their promising role as diagnostic and prognostic biomarkers in cardiovascular diseases

Aim of the work: To identify whether miRNA-1 is a dependable biomarker for diagnosis of acute myocardial infarction or not

Subjects and Methods: 69 patients with coronary artery disease were included in this study; 36 patients with AMI and 33 patients with unstable angina. Those patients were admitted to coronary care unit, Assuit University Hospital during the period of March to October 2014. In addition 22 apparently healthy subjects were included as a control group. Cardiac troponin I and miRNA-1 was done for all subjects

Results: In patients with AMI the results of miRNA-1 ranged from 28.3 - 6763.9 fold changes above the control level. In those with UA, miRNA-1 result ranged from 1.74 - 144.37 fold changes above the control level [when the control group is one fold]. Comparison between different cups regarding results of miRNA-1 revealed that there was a highly significant difference [P<0.001] between different groups. There was a highly significant increase in patients with AMI when compared with the control group, also a statistically significant increase [P<0.001] in patients with UA when compared with the control group and a statistically significant increase [P<0.001] in patients with AMI when compared with those of UA

Conclusion: miRNA-1 is a novel dependable biomarker in patients with acute coronary syndrome. It shows significant upregulation in patients with AMI, but this upregulation is far from that of UA

Diagnostic values of gene expression of cytokeratin - 19 mrna and mammaglobin mrna in breast cancer patients using real-time polymerase chain reaction

Breast cancer is the most frequent cancer in women. It constitutes almost 20% of all malignancies in women. Currently it affects approximately 6% of the female population. Even before clinical detection of a primary tumour, cancer cells can invade the adjacent structures from where they travel through lymphatic and blood vessels as circulating tumour cells [CTCs]. CTCs colonize distant organ sites as disseminated tumour cells [DTCs] and eventually form microscopic deposits [micrometastasis < 2 mm in diameter], which may remain dormant, but then ultimately lead to an overt metastatic disease. Cytokeratins [CKs] have become the most widely accepted protein markers for the detection of epithelial tumour cells in mesenchymal tissues, BM, blood and lymph nodes. Based on its breast cancer-association and somewhat unique breast-specific pattern of expression, mammaglobin was believed to be an excellent candidate for a novel and clinically useful breast tumor marker, especially in detecting micrometastasis. This study was performed on one hundred female Individuals. They classified into: Group I: 20 apparently healthy females as control group. Group II: 20 females with stage I breast cancer . Group HI: 20 females with stage II breast cancer. Group IV: 20 females with stage III breast cancer. Group V: 20 females with stage IV breast cancer. The following specific investigations were done for all the studied persons:-Cancer Antigen 15-3 [CA15-3] and Carcinoembryonic Antigen [CEA] using chemilmnmescent immunometric assay [IMMULITE 1000 Analyzer]. Cytokeratin-19 mRNA [CK-19] mRNA and mammaglobin mRNA by Real-time polymerase chain reaction [RT-PCR]. In group I [control group]: All the 20 healthy control females had low expression values for CK-19 and Mammaglobin. In group 2 [stage I breast cancer]: 35% of patients had over expression values for CK-19 and 20% had over expression values for Mammaglobin. In group 3[stage II breast cancer]: 47.4% of patients had over expression values for CK-19 and 47.4% had over expression values for Mammaglobin. In group 4 [stage III breast cancer] 68.4% of patients had over expression values for CK-19 and 73.7% had over expression values for Mammaglobin. In group 5 [stage IV breast cancer]: 95% of patients had over expression values for CK-19 and 95% had over expression values for Mammaglobin. Our findings support that all patients with breast cancer should be evaluated by CK-19 and Mammaglobin as a regular laboratory assessment beside the routine tumour markers specially in early stages of breast cancer to detect CTCs at the time of diagnosis

Evaluation of different methods for the detection of KPC b-lactamase in Klebsiella pneumoniae and escherichia coli

The worldwide increase in the occurrence and dissemination of Klebsiella pneumoniae carbapenemase [KPC] among Gram-negative pathogens makes critical the early detection of these enzymes. The aim of this study is the evaluation of the most appropriate method for the detection and identification of KPC producing Klebsiella pneumonia and Escherichia coli. Modified Hodge test [MHT], Boronic acid lest [BAT] and polymerase chain reaction [PCR] were evaluated for the detection of KPC-possessing isolates. A total of 60 urine samples and 60 sputum samples were collected from 79 patients in Chest Intensive Care Unit and Trauma intensive Care Unit in Assiut University Hospital. Sixty four isolates [26 Klebsiella pneumonia and 38 E. coil] were identified by conventional methods. The antibiotic susceptibility testing of isolates showed that 19% were resistant to meropenem, 17% were resistant to imipenem and 95% were resistant to ertapenem. Thirty seven isolates were MHT positive while twenty three only of them were Boronic acid and PCR positive. The results indicate that the MHT lack sensitivity while Boronic acid test is an excellent inhibitor of KPCs. PCR is the standard method for the detection of the KPCs but it's highly expensive

Perioperative effects of various anesthetic adjuvants with TIVA guided by bispectral index / 대한마취과학회지

BACKGROUND: This prospective, randomized, double blinded, controlled study was designed to compare effects of intravenous co-administration of clonidine, magnesium, or ketamine on anesthetic consumption, intraoperative hemodynamics, postoperative analgesia and recovery indices during Bispectral Index (BIS) guided total intravenous anesthesia (TIVA). METHODS: After ethical committee approval and written informed consent, 120 adult patients ASA I and II scheduled for open cholecystectomy were randomly assigned to one of 4 equal groups. Group CL received clonidine 3 microg/kg and maintained by 2 microg/kg/h. Group MG received magnesium sulphate 50 mg/kg and maintained by 8 mg/kg/h. Group KET received racemic ketamine 0.4 mg/kg and maintained by 0.2 mg/kg/h. Control group (CT) received the same volume of isotonic saline. Anesthesia was induced and maintained by fentanyl, propofol and rocuronium. Propofol infusion was adjusted to keep the BIS value between 45-55. Intraoperative hemodynamics, induction time, anesthetic consumption, recovery indices, and PACU discharge were recorded. RESULTS: Induction time, propofol requirements for induction and maintenance of anesthesia, intraoperative fentanyl and hemodynamic values were significantly lower with Groups CL and MG compared to Groups KET and CT (P < 0.05). Patients in Group MG showed significantly lower muscle relaxant consumption, delayed recovery and PACU discharge than other groups (P < 0.05). First, analgesic requirement was significantly longer and total postoperative analgesic consumption was significantly lower in the adjuvant groups versus Group CT (P < 0.05). CONCLUSIONS: Clonidine, magnesium, and ketamine can be useful adjuvant agents to BIS-guided TIVA. Pharmacokinetic studies of such drug combinations were recommended to investigate their interaction.

In vivo effects of different anesthetic agents on apoptosis / 대한마취과학회지

BACKGROUND: This study was designed to measure in vivo effects of propofol, isoflurane and sevoflurane on apoptosis by measuring caspase-3 and tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) blood level as apoptotic markers. METHODS: After obtaining ethical committee approval and informed written consents, sixty adult patients ASA I scheduled for open cholecystectomy participated in this study. They were randomally allocated into one of three equal groups to receive propofol infusion, low-flow isoflurane or sevoflurane for maintenance of anesthesia. Venous blood samples were collected preoperatively, immediately postoperative and after 24 hours to measure hemoglobin, hematocrit, creatinine, liver enzymes, serum TRAIL and caspase-3 levels. RESULTS: There was no significant difference in hematological markers and serum creatinine. Liver enzymes showed significant postoperative rise (P < 0.05). In Propofol group, TRAIL and caspase-3 levels were significantly elevated immediately postoperative then decreased significantly after 24-hours (P < 0.05). In Isoflurane group, immediate postoperative level of TRAIL was significantly higher than 24 hours reading and significantly lower than its level in Propofol group at the same timing meanwhile caspase-3 levels were comparable at different timings. In Sevoflurane group, TRAIL and caspase-3 levels increased significantly in both postoperative samples than preoperative level and than those of Isoflurane and Propofol groups after 24 hours concerning TRAIL (P & 0.05). CONCLUSIONS: This study concluded that isoflurane is superior and sevoflurane is the least effective among the three anesthetics in protection against apoptosis. This study neither proved nor excluded propofol-induced apoptosis. Further studies are required during lengthy procedure and in compromised patients.

Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old

All patients undergoing major abdominal procedures have some degree of gastric atony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide. antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin [250 mg], altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients [20 each] were allocated randomly to receive orally, either erythromycin 250 mg [E250] or erythromycin 500 mg [E500], or 10 mg metoclopramide [M], or 4mg ondansetron [Z], an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250mg elicited a significantly lower residual gastric volume [P<0.001] and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z [100, 10 and 10 %] compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin [250 mg], given1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron

Role of cholinesterase activity on pharmacodynamics of mivacurium preceded by pancuronium in elderly and young adults

Mivacurium- pancuronium combination proved to be more potent than either drug given alone. The goal of this study was to evaluate the safety and efficacy of this combination in elderly group and its correlation to plasma butyryl cholinesterase [Bche] activity. Forty patients, ASA I or II scheduled for elective open cholecystectomy were allocated into two groups of twenty patients each: young group [18- 55 years] and elderly group [60-75 years]. Anesthesia was induced with midazolam, fentanyl, and propofol then maintained with isoflurane and opioid supplementation. Neuromuscular blockade [NMB] was monitored by train-of-four [TOF] stimulation of the ulnar nerve. After calibration, NMB was achieved by 16 micro g kg[-1] pancuronium followed by 32 micro g kg[-1] mivacurium. The following parameters were recorded: The onset time, clinical duration, recovery index and the total dose of mivacurium and pancuronium together with hemodynamic data. Three blood samples for Bche activity were collected: before pancuronium injection, 3 min. and 30 min. afterwards in both groups. The onset time and the recovery index of NMB were comparable in both groups. The duration of action was significantly prolonged in elderly group [49.8 +/- 10.48 min.] compared to young one [37.13 +/- 7.81 min.]. The total dose of mivacurium was significantly less in the elderly group [22.56 +/- 2.39 micro g kg[-1] hr[-1]] when compared to the young group [25.78 +/- 3.05 micro g kg[-1] hr[-1]]. For all patients, the preoperative Bche activity was within the normal range. After pancuronium injection, it showed a significant reduction in both groups at three and thirty minutes except a non significant value in young at thirty minutes. This reduction showed a significantly higher percent change in the elderly group [30.37 +/- 22.01] than the young group [8.60 +/- 19.19] at thirty minutes. There were significant intra operative variations in the percent changes of hemodynamic data compared to the preoperative values, yet, still within the clinically acceptable range. So, the use of a small dose of pancuronium followed by a small dose of mivacurium with a ratio of 1:2 can produce synergism without affecting either the recovery profile of mivacurium or the clinical hemodynamic stability even in the elderly group

Effects of different dose regimens of magnesium on pharmacodynamics and anesthetic requirements of balanced general anesthesia

The present double- blind, randomized, placebo- controlled study was designed to assess the effect of two different dose regimens of magnesium sulphate [MgSO[4] administration on intraoperative propofol and vecuronium requirements and postoperative fentanyl consumption in patients undergoing hernioraphy. Sixty patients were allocated to three equal groups; two magnesium groups and control group. Magnesium groups received 50 mg kg[-1] of magnesium preoperatively followed by intravenous infusion of magnesium 8 mg kg[-1] h[-1] [Mgl G] or 16 mg kg[-1]h[-1] [Mg2 G]. Patients in control group received the same volume of isotonic solution. Anesthesia was induced and maintained with propofol, fentanyl, and vecuronium. Magnesium Gs required significantly lower propofol [121.0 +/- 4.5, 117.4 +/- 6.3 micro g kg[-1] min.[-1] in Mgl and Mg2 Gs respectively vs. 153.8 +/- 8.4 micro g kg[-1] min.[-1] in control G], and vecuronium requirements [0.097 +/- 0.008, 0.092 +/- 0.006 mg kg[-1] h[-1] in Mgl and Mg2 Gs respectively vs. 0.124 +/- 0.01 mg kg[-1] h in control G]. Magnesium significantly shortened the onset time of vecuronium [154.0 +/- 25.9, 162.0 +/- 22.4 sec. in Mgl and Mg2 Gs respectively vs. 227.4 +/- 10.9 sec. in control], prolonged its clinical duration [44.7 +/- 3.2, 46.4 +/- 5.1 min. in Mgl and Mg2 Gs respectively vs. 26.0 +/- 3.9 min. in control] and prolonged its recovery index which was significantly longest in Mg2 G [25.4 +/- 1.9 min.] compared to Mgl G [20.1 +/- 2.1 min.] and control [15.3 +/- 1.4 min.] Fentanyl consumption on the first postoperative day was significantly higher in control [1.52 +/- 0.08 micro g kg[-1] than in magnesium Gs [0.96 +/- 0.07, 0.91 +/- 0.08 micro g kg[-1] in Mgl and Mg2 Gs respectively]. Postoperative sedation score showed significantly the highest value in Mg2 G compared to Mgl and control Gs. Mean arterial blood pressure and heart rate were lower in magnesium groups with lowest value in Mg2 G. It is concluded that magnesium 50 mg kg[-1] bolus followed by 8 mg kg[-1] h[-1] leads to significant reductions in intraoperative propofol and vecuronium and postoperative fentanyl consumption. Doubling magnesium infusion rate added minimal benefits on the expense of haemodynamic consequences and delayed recovery

Measurement of serum soluble Fas and soluble Fas ligand as markers of apoptosis in children with congestive heart failure

Apoptosis plays a pivotal role in the progression of the pathogenesis of several cardiovascular diseases including heart failure. The aim of this study was to measure serum levels of soluble apoptosis mediators; Fas [sFas] and Fas ligand [sFasL] in children with congestive heart failure [CHF] of different etiologies, and their relation to each other and to the severity of heart failure in these patients. Sixty patients [29 males and 31 females, age; 6.73 +/- 3.18 years] complaining from congestive head failure [NYHA class III/IV] selected from the pediatric department in Al-Minya [university Hospital, from the period of February 2004 to July 2005. The patients were divided into 3 groups according to the etiology of heart failure. Group 1, caused by congenital heart disease [CHD] in 18 cases, group 2 caused by rheumatic valvular head disease [RHD] in 29 cases, and group 3, caused by dilated cardiomyopathy [DCM], in 13 cases. Twenty healthy children, matched for age and gender, were used as controls. Serum levels of soluble Fas [sFas] and Fas-ligand in patients and controls were determined by Enzyme-Linked lmmuno-Sorbent Assay. The results showed that the serum levels of sFas and sFasL were significantly higher in patients with CHF compared to controls [p: 0.001 and p: 0.04, respectively]. Patients with CHF due to CHD had significantly higher levels of sFas and sFasL compared to controls [p: 0.001 and p: 0.002 respectively]. Also, patients with CHF due to RHD had significantly higher levels of sFas and FasL compared to controls [p: 0.001 and p; 0.04 respectively]. Similarly, patients with DCM had significantly higher levels of sFas and FasL compared to control group [p: 0.001 and p: 0.005 respectively]. Serum FasL correlated positively to sFas [r: 0.32, p: 0.049], and heart rate [r: 0.30, p: 0.044], and correlated negatively to ejection fraction [r: -0.46, p: 0.03], but had no significant correlation with ESR, or CRP. Serum levels of sFas and sFasL are increased in children with CHF of different etiologies suggesting a potential role of Fas and FasL in this setting. Levels of sFasL are increased in proportion to the severity of heart failure and may provide a useful marker for evaluating the severity and prognosis of heart failure

Serum troponin in neonates of pre-eclamptic mothers

Cardiac troponin I, the biochemical marker of myocardial injury is characterized by high sensitivity and specificity in comparison with other markers used in the past. The aim of this study was to evaluate serum levels of troponin in neonates of pre-eclamptic mothers compared with levels in age and sex matched controls, and to correlate the levels of troponin I with Cardiac Creatine Kinase [CK-MB] and other markers of myocardial injury. Forty neonates of pre-eclamptic mothers were included in the study [group A]. Also, 30 age and sex matched healthy neonates were included as controls [group B]. All neonates were subjected to full clinical assessment and routine laboratory investigations. Echocardiographic study was done stressing on myocardial contractility, and calculating the E/A ratio where E= Mitral peak velocity of early diastole in centimeters per second, and A Peak velocity of the atrial contraction in centimeters per second. Cardiac troponin [was measured in serum by ELIZA. CK-MB was measured in serum by chemical analysis. The results showed that troponin I, CK-MB, and E/A levels were significantly higher in group A compared with group B [p=0.003, p=0.03, and p=0.01 respectively]. There were significant positive correlations between troponin I with CK-MB, C-reactive protein and the mean E/A value in group A [r=0.86; p=0.02, r=0.50; p=0.01, and r=0.75; p=0.05 respectively]. Troponin I had a sensitivity of 83.3% and a sensitivity of 86.6% in diagnosing myocardial injury while CK-MB had a sensitivity of 75% and a specificity of 76% in diagnosing myocardial injury. From the present study we conclude that cardiac Troponin I is a more specific and more sensitive marker for myocardial injury than the standard biochemical markers such as CK-MB and it can detect minor myocardial damage not diagnosed early by echo cardio graphic study. Also we conclude that preterm neonates of preeclamptic mothers are more susceptible to myocardial injury than full-term neonates. Troponin I may have prognostic significance because, if present, it identifies the neonates of pre-eclamptic mothers who are at risk of cardiac injury

Study of frequency and responsible factors for post stroke depression in stroke patients coming to Mayo Hospital Lahore

Post stroke depression develops as a complication after stroke and impedes the recovery process. Different factors responsible for the development of depression include severity of paralysis, low functional and socioeconomic status and duration of stroke. Our objective was to find out the frequency and responsible factors for PSD in patients presenting to Mayo Hospital Lahore. In a descriptive design 174 patients were studied in out door clinics of Mayo Hospital Lahore. Depression was diagnosed on the basis of DSM IV and severity of stroke was evaluated on the basis of Barthel Index. Results showed that 37.9% of patients had post stroke depression and majority of patients with PSD came with in first 3 months after stroke. We also found that there is a linear relationship [R2 = 0.844] between severity of stroke and PSD. Hence we concluded that PSD developed in almost one third of patients of stroke, is associated with duration and severity of stroke, developing more commonly with in first 3 months

Plasma interleukin-11 levels in thrombocytopenic and non-thrombocytopenic neonates

Thrombocytopenia is common in sick neonates, and affected neonates have adverse outcomes compared with those without thrombocytopenia. As impaired platelet production underlies many neonatal thrombocytopenias, affected neonates are potential candidates for hemopoietic growth factor therapy. The thrombopoietic cytokine recombinant human IL-11, which stimulates megakaryocytopoiesis and increases platelet counts after chemotherapy, is already licensed for clinical use. However, little is known about IL-11 in neonates. We therefore measured plasma IL-11 by ELISA in healthy term neonates, stable preterm neonates with or without thrombocytopenia, and preterm neonates with sepsis or necrotizing enterocolitis [NEC] with or without thrombocytopenia. At birth IL-11 was undertetable [<10pg/ml] in healthy term neonates [n = 15] and 21 of 25 [84%] stable preterm neonates. Three stable preterm neonates had detectable plasma IL-11[mean, 11.23 +/- 0.64 pg/ml], all three were born after pregnancies complicated by prolonged rupture of membranes or chorioamnionitis, the remaining neonate[IL-11, 15 pg/ml] being one of seven with early onset thrombocytopenia [presented by 72 h of age]. IL-11 was also measured in 50 preterm neonates with suspected sepsis or NEC. In 20 of 50, sepsis or NEC was unconfirmed and IL-11 was undetectable, in contrast, 14 of 30 with proven sepsis or NEC had elevated IL-11 [mean, 25.41 +/- 21.3; range, 11.3-93 pg/ml] [p = 0.0003]. Of the 30 neonates with proven sepsis or NEC, 19 developed thrombocytopenia: nine of 19 [47.4%] had detectable IL-11 and 10 of 19 [52.6%] did not [p = 0.746]. Although the role of IL-11 in platelet production in neonates remains unclear, these data suggest that IL-11 is involved in the endogenous cytokine response to sepsis or NEC in preterm neonates. Further studies of IL-11 in neonates are warranted to assess its role both in platelet production and in mediation of the endogenous inflammatory response

Correlation of fracture index with BMD T-score in postmenopausal females

To find the correlation between Fracture Index and BMD T-score so that fracture index can be used as a predictive tool for fracture risk estimation in post menopausal females. Design: A cross-sectional study was conducted on a sample of 396 women age 50 years and above. BMD T-score measurements using ultrasound and Fracture Index calculations based on the risk factor assessment were performed. Setting: North Medical Ward, Unit 4 Et Out Patient Clinics, Mayo Hospital and Akram Medical complex, Lahore. Main outcome: Use of Fracture Index as a predictive tool for the estimation of fracture risk in post menopausal females. The study results showed that when Fracture Index increases BMD T-score decreases to osteoporotic range and correlation coefficient is -0.162. When Fracture Index increases, BMD T-score decreases therefore we can use Fracture Index as an assessment tool for predicting fracture risk in postmenopausal females

Botulinum toxin - treatment of choice for primary hyperhidrosis?

The term Botulinum toxin encompasses a group of seven [A - G] immunologically distinct Zinc-dependent endoproteases that act primarily at peripheral cholinergic synapses. By blocking synaptic vesicle trafficking they effectively block the release of Acetylcholine inducing muscle paralysis. This property is utilized in the treatment of conditions such as blepharospasm, torticollis and focal dystonias

Hypermethylation of the PAX 5 gene promoter and its implication in the pathogenesis of multiple myeloma

This study aimed to clarify the mechanism of silencing of the PAX5 gene. The genetic analysis of the coding region and promoter by southern blot analysis did not show growth structural abnormalities in human multiple myeloma [MM] cell lines when compared with PAX5 expressing B cells. Several transcription factors like Ikaros-1 [IK-1] and SRY-related high mobility group [HMG] box [SOX4 and SOX5] showed a similar expression pattern in B cells and MM cells. Therefore, it was suggested that epigenetic factors could be involved in PAX5 silencing. The examination of the methylation pattern in PAX5 promoter revealed some areas of hypermethylation in methylation sensitive Southern blot analysis. Moreover, the treatment of MM cell lines by methylation blocking cytidine analogue 5-aza-2 deoxycytidine [5-aza-2dC] could restore the expression of PAX5 gene. It was postulated that hypermethylation of the PAX5 gene promoter may be responsible for its silencing in human MM. It was proposed that PAX5 gene silencing could be related to the oncogenesis of human MM

Fas and BCL-2 oncoprotein as an apoptotic markers in HCV- positive blood donors

To study the factor of apoptotic signal [FAS] amid B-cell leukemia lymphoma [BCL-2] oncoprotein as markers of apoptosis in blood donors. The study included 121 voluntary blood donors attending the Blood Bank of El-Minia University Hospital. They were divided into three groups according to HCV antibodies and qualitative HCV-RNA PCR: Group I: HCV antibodies and RNA- PCR negative [n =40], Group II: HCV antibodies positive and- RNA- PCR positive without liver cirrhosis [n=70] and Group III: HCV antibodies positive and- RNA- PCR positive with liver cirrhosis [n=11]. Each subject was submitted for the following investigations: Complete blood count, liver function tests, alpha fetoprotein assay by ELISA method, FAS [CD95] antigen, and intracellular BCL-2 oncoprotein on lymphocytes by flow cytometry. FAS is significantly higher in group II and group III when compared with that in group I [P=0.0 for both]. On comparing group III with group II, also FAS is significantly higher in group III [P=0.021]. Significant positive correlation between FAS and both ALT, AST, and AFP was found [r =0.39, 0.47and 0.39 respectively and P = 0.0 for all] while there was significant negative correlation between FAS and both platelets and albumin [r= -0.52 and -0.46 respectively and P = 0.0 for both] in the total diseased group [group II + III]. BCL-2 is significantly higher in group II and group Ill when compared with that in group I [P=0.001 and 0.0 respectively]. On comparing group Ill with group II, also BCL-2 is significantly higher in group III [P= 0.0]. Significant positive correlation was found between BCL-2 and ALT, AST, and AFP [r= 0.29, 0.39and 0.41 respectively and P= 0.0 for all], while there was a significant negative correlation between BCL-2 and both platelets and albumin in the total diseased group [r= -0.53 and -0.41 respectively and P= 0.0 for both]. A significant positive correlation was found between FAS and BCL-2 in the diseased group [r=0.321 and p=0.007]. FAS and BCL-2 as an apoptotic markers play an important role in the pathogenesis and further outcome of chronic liver diseases

Stoppa preperitoneal approach [GPRVS] versus laparoscopic TAPP approach in management of bilateral inguinal hernia: a multicenter study

The preperitoneal approach for inguinal hernia avoids distorting the inguinal anatomy, markedly reducing the risk of damage to the testicular vessels and permits inspection of all potential groin hernia sites. In this, study we are trying to validate and compare two preperitoneal approaches used for repairing bilateral inguinal hernias; the Stoppa [GPRVS, giant prosthetic reinforcement of the visceral sac] and the laparoscopic transabdominal approach [TAPP]. Two hundred forty two [242] patients with bilateral inguinal hernia were treated at 3 University hospitals. They were randomly divided into two groups the first group [gp I] was 97 patients and underwent laparoscopic TAPP repair while the second group [gp II] was 143 patients and submitted for Stoppa preperitoneal repair [5 patients were turned from TAPP to Stoppa repair due to instrument failure in 2 patients, adherent intestinal loops with difficult reduction of the contents in 2 patients and bleeding from inferior epigastric vessel in l patient]. Operative time was 110 +/- 65 min in TAPP group and 90 +/- 20 min in Stoppa group. Hospital stay and need for analgesics were less with TAPP group than Stoppa group. Recurrence rate was- 5.1% in TAPP group and 2.1% in Stoppa group. Complications were slightly higher with Stoppa group except for chronic groin pain which was higher with TAPP. Both Stoppa and TAPP are valid preperitoneal repairs for bilateral inguinal hernias. Both are techniqually demanding operations. Stoppa has fewer recurrences but has slightly higher complication rate except for chronic groin pain which is more reported after TAPP. TAPP has the advantages of posing smoother postoperative course with shorter hospital stay

Helicobacter pylori seropositivity: its correlation with vomiting disorders during pregnancy

To evaluate the relationship between Helicobacter pylori [H. pylori] infection and vomiting disorders during pregnancy. Helicobacter pylori IgG antibodies were determined in three groups of pregnant women by ELISA. Group I included 25 pregnant women with hyperemesis gravidarum [HG], group II included 60 pregnant women with emesis gravidarum [EG] and group III included 60 asymptomatic pregnant women [NP] of matched age and parity. The percentage of IgG seropositivity and the mean IgG liter in each group were determined and analysed. El-Minia University Hospital. The prevalence of seropositivity for H. pylori IgG antibodies among patients with [HG] [21 out of 25 = 84%] was higher than those with [EG] [34 out of 60 = 56.67%] and also higher than that in asymptomatic pregnant women [32 out of 60 = 53.33%]. This difference was statistically significant [P < 0.05]. Also the mean liter in the first group was [55.64 +/- 7.2 Au/ml] compared to [40.41 +/- 18.2 Au/ml] and [31.52 +/- 11.34 An/ml] in the second and third groups respectively. This difference in the mean titer was statistically significant [P < 0.05]. Helicobacter pylori infection appears to be significantly associated with [HG] and accordingly, serologic testing for this infection will be of great help in the management of these patients

Hemostatic changes and autoantibody formation in otherwise healthy children with acute varicella infection

In this study, blood samples were obtained from 20 children with varicella without thrombosis during acute varicella infection. The study included as well 20 healthy controls. Coagulation tests included determination of the prothrombin time, activated partial thromboplastin time, thrombin time, prothrombin fragment 1+2 and free protein S. Blood was assayed also for the D-dimer, antibody binding to protein S, lupus anticoagulant, antiphospholipid antibody and anticardiolipin antibody. The results revealed that the mean free protein S concentration in children with acute varicella was significantly decreased compared to the controls. Thrombin time, D- dimer and prothrombin fragment 1+2 were significantly increased in children with acute varicella compared to that of the controls. There was a significantly increased prevalence of lupus anticoagulant, antiphospholipid antibody, anticardiolipin antibody and antibody binding to protein S in children with acute varicella. Elevated protein S IgG antibody in children with acute varicella showed statistically significant negative correlation with free protein S and positive correlation with prothrombin fragment 1+2. Plasma concentrations of free protein S were reduced and plasma levels of D- dimer and prothrombin fragment 1+2 were elevated in otherwise healthy children with acute varicella infection. Also, these children showed increased prevalence of lupus anticoagulant, antiphospholipid antibody and anticardiolipin antibody

Renin-angiotensin II -aldosterone axis disturbances in patients with chronic obstructive pulmonary disease

To study the possible disturbances of renin-angiotensin II Aldosterone system [RAAS] in chronic obstructive pulmonary disease [COPD] patients, this work was conducted. It included 45 COPD and 10 healthy control volunteers. Both plasma renin activity [PRA] and plasma aldosterone [PA] were measured in patients and controls by radioimmunoassay [RIA] and the results were plotted against clinical and functional data as well as serum and urinary electrolytes. In COPD patients, PRA and PA levels [means +/- SD were 4.4 +/- 1.16 ng/ml/h and 132 +/- 44pg/ml us 1.2 +/- 0.26 ng/ml/h. and 65 +/- 3pg/ml respectively, were significantly higher than those of controls, and positively correlated with each other. There was no effect of sex, body weight or age on the RAAS, while a significant positive correlation between smoking and PRA was found. Greater RAAS stimulation was observed in the presence of peripheral edema and with advancement of hypercapnia, hypoxemia and airway obstruction. Inability to excrete sodium, in urine was the most prominent electrolyte disturbance in advanced COPD. Mechanical ventilation was associated with further stimulation of RAAS. In conclusion, RAAS is frequently stimulated in COPD patients especially in advanced stages of the disease, leading to a state of secondary hyperaldosteronism of the hyperreninemic type that may contribute to sodium retention and edema formation. Hypercapnia and, to lesser degree, hypoxemia may be the most accused predisposing factors for RAAS stimulation