impact of splenectomy on the patient's susceptability to infection

Splenectomy, is a procedure that has significantly decreased in frequency as the understanding of its complications increase. Susceptibility to infection is the best-defined and most widely understood complication of splenectomy. The aim was to study the impact of splenectomy on the patients susceptibility to infections, and its effect on morbidity and mortality statistics of patients admitted to fever hospitals. The study included 506 patients admitted to fever hospital and they divided according to history of splenectomy into group 1 of 432 patients with no history of splenectomy and group II of 74 patients with history of splenectomy. The cause and duration of splenectomy, hospital stay, the type and duration of antibiotic prescribed in hospital the diagnosis and the outcome at discharge were the main history items. Chronic liver disease [CLD] was the main cause of splenectomy followed by trauma and Thalassemia 67%, 20% and 12% respectively. No significant difference in blood culture between the 2 group but capsulated organism were more in group II. Respiratory tract infection was the main cause of admission in both groups with a high incidence of respiratory, urinary tract infection, meningitis and pyrexia of unknown origin in group II. Quinolones, Penicillin and Cephalosporins were the commonly used groups of antibiotics with statistical difference in group 2 than group 1. Prolonged hospital stay in group II with high statistical difference than group I [14.07 +/- 8.68 versus 4.57 +/- 3.29] [P<0.001]. The improved outcome were significantly higher in group 1 than group 2 and the not improved outcome [frequent admission, escape from hospital and university hospital referral] were higher in group 2 than group 1 and it correlate with duration of splenectomy

Neurophysiologic and psychometric changes in patients with liver cirrhosis

Because of its prognostic and socioeconomic relevance, interest has focused on SHE, which describes a poorly defined syndrome found in the grey zone between normality and manifest HE. the aim was to study the neurophysiologic and nero psychologic changes in chronic liver diseases to diagnoses subclinical heptic encephalopathy [SHE]. Sixty patients with chronic liver disease 30 had cirrhosis due to chronic HCV [group 1], and 30 patients had liver fibrosis due to Schistosomiasis [alone or with hepatitis] [group2]. and 20 healthy subjects as control [group 3], all were subjected to, clinical examination, assessment of liver function, routine tab., investigations, Abd, US. and EEG and psychometric assessment by [NCT] and symbol [SDT]. NCT abnormal score was found in 46.7% group2. ranging from 42.3% to 75% in Child-Pugh grade A, B respectively, however the control group had normal NCT score. Positive EEG changes were in [60%]and [50%] ranging from [47.05% to 76.92%] and from [46.15% to 75.0%], in group 1 and group 2 in Child-Pugh grade A and B, respectively, while in group 3 EEG was normal in [90%] and non specific changes found in[10%]. EEC changes and psychometric defects were detected in considerable percentage of cirrhotic patients and were related to the severity of liver cirrhosis, so psychometric tests and EEG may be suitable tools for diagnosis of SHE

Correlation between serum and gastric levels of tumor necrosis factor - alpha and interleukin - 8 in patients with Helicobacter Pylori infection

This study was carried out to determine the rate of H. pylori infection among dyspeptic patients and to investigate if there is a correlation between the inflammatory cytokines, TNF-a and IL-8 and the mucosal damage observed in H. pylori infected patients by comparing the mucosal levels of these two cytokines with their serum levels and the endoscopic diagnosis. Two prepyloric antral biopsy specimens, serum samples and gastric juice were collected from 60 dyspeptic patients, 50 with gastr oduedenal lesion [20 with gastritis, 9 with duodenitis, 9 with gastric ulcer and 12 with duodenal ulcer] and 10 with normal endoscopic findings [control group]. It was found that, out of 60 dyspeptic patients, 32 were found positive for H.pylori [53.3%], out of these 32 cases, 30 [93.75%] were symptomatic and had different gastroduodenal lesions, and 2 cases [6.25%] were asymptomatic and diagnosed as functional dyspepsia. The rate of infection is significant only in the patient group with gastroduodenal lesion compared to the control group. [p < 0.05] .The prevalence of H. pylori infection among patients with non-ulcer dyspepsia is [45%] while its prevalenc among patients with gastric or duodenal ulcer is [81%]. The difference in prevalence is statistically highly significant [P< 0.01]. It was found that the rate of H.pylori infection is higher in males [78.12%] than females [21.87%] and in patients more than 40 years old [68.75%] than those less than 40 years old [31.25%]. The levels of TNF-a and IL8 in gastric juice of patients with gastroduodenal lesion were significantly higher than those of controls [p < 0.001] Also, the levels of IL8 in serum of patients with gastroduedenal lesions were significantly higher than those of controls. However, the serum levels of TNF-a in these patients did not differ significantly from those of controls [P > 0.05] The levels of TNF and IL8 in both the gastric juice and serum of patients with ulcer dyspepsia [gastric and duodenal ulcer] were significantly higher than those of patients with non-ulcer dyspepsia Also, the levels of TNF-a and IL8 in gastric juice samples of H. pylori-positive patients with gastroduodenal lesions were significantly higher than those of H. pylori-negativc ones. To the contrary serum levels of TNF-a and IL8 of H. pylori-positive patient did not show a statistically significant difference from those of H. pylori-negative cases. Moreover, a statistically significant positive correlation was found between the levels of TNF-a and IL8 in gastric juice of patient positive for H. pylori. This study concluded that the increased gastric production of IL8 and TN F-a may be implicated in the pathogenesis of H. pylori associated gastroduodenal diseases, and understanding the potential role of these two cytokines in inflammation may provide a new basis for the design of anti-inflammatory agents used in treatment