Helicobacter pylori in dyspeptic hemodialysed patients: endoscopy findings and non-invasive detection

Objective: We aimed to evaluate dyspeptic hemodialysed patients regarding upper endoscopy findings and HP status. Also to determine the accuracy of several tests, including culture, histology, rapid urease test, serology and Hp stool antigen to screen for H. pylori infection in dyspeptic hemodialysed patients and evaluate the success of eradication therapy in patients with ESRD

Patients and methods: 44 patients with ESRD on regular hemodialysis and 40 dyspeptic patients with normal renal function as a control group were included in the study. All patients underwent upper endoscopy with biopsy intake for HP histopathology, culture and rapid urease test [RUT]. HP positive result was based on histopathology and or culture. HpSA, and Hp-lgG were also performed. HP infected patients were scheduled to undergo 7-day triple therapy and the success of eradication therapy was investigated

Results: 20 of ESRD patients [54.5%] and 25 patients of control group [62.5%] were proven to be infected with HP. The endoscopy findings of the gastroduodenal mucosa in dialysis patients were similar to that of controls, as was the incidence of peptic ulcers. Dialysis patients had a significantly lower prevalence of H. pylori infection than control subjects. In the histological study. H. pylori-positive patients had significantly higher inflammation and activity scores than H. pylori-negative patients for both dialysis patients and controls. The culture technique provided sensitivity, specificity, PPV and NPV of 54.9, 100, 100 and 70.6%, respectively. The CLO test provided sensitivity, specificity, PPV and NPV of 98, 90.0, 92.1 and 98.9%, respectively. The histology provided sensitivity, specificity, PPV and NPV of 93.4, 90.6, 90.5 and 94.0 %, respectively. The serological test of IgG antibodies yielded sensitivity, specificity, PPV and NPV of 96.0, 64.0, 78.6 and 95.9%, respectively. For the detection of HPSA using FemtoLAB yielded sensitivity, specificity, PPV and NPV of 86.0 100, 100, and 91.0%, respectively, using Premier Platinum yielded sensitivity, specificity, PPV and NPV of 58.0, 86.0 92.0 and 53.0%, respectively, simple rapid test yielded sensitivity. specificity. PPV and NPV of 61.0% 78%, 74.0% and 67% respectively

Conclusion: Upper GI abnormalities are common among HD patients. Biopsy proven antral gastritis is the most common histological diagnosis among these patients and is highly associated with H. pylori infection. Prevalence of H.pylori infection in HD patients is similar to those with normal renal function undergoing endoscopy for dyspepsia. FemtoLAB HpSA is a noninvasive reliable. inexpensive, and reproducible test for diagnosis and follow up of eradication of HP infection in ESRD patients on regular hemodialysis. Detection and treatment of HP improved dyspeptic symptoms in ESRD patients on hemodialysis

Molecular cytogenetic analysis of prognostically important chromosomal aberrations in childhood acute lymphoblastic leukemia

Background: Although detection of chromosome aberrations in ALL has been improved by the development of cytogenetic techniques in conventional G-banding analysis, prognostically important structural or numerical chromosome aberrations may frequently go undetected using conventional G-banding alone due to poor chromosome morphology and few malignant metaphases

Objectives: The present study was designed to estimate the incidences of different genetic subgroups in childhood ALL with abnormalities involving BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions using FISH technique and conventional cytogenetic analysis. We tried to demonstrate the usefulness of FISH technique

Subjects and Methods: This study was conducted on BM and/or BP from 48 patients with childhood ALL. Their age range from 2-13 years mean age was 6.7 years. Patients were followed-up for 18 months [range 14-28 months]. Morphological, cytochemical, immunophenotyping, cytogenetic and FISH analysis were performed for every patient. FISH was performed with probes for BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions for each case of childhood ALL

Results: Numerical and/or structural aberrations were identified in 52.1% of all cases by conventional G-banding alone. Numerical and/or structural aberrations were identified in 75% of all cases by the combination of conventional G-banding and interphase FISH. Gene rearrangements were disclosed by FISH in 11 [47.8%] of 23 patients who showed a normal banded karyotype or no mitotic cell in G-banding. The most common gene rearrangement was p16 deletion [21.27%] and the incidences of others were 15.9% for TEL/AML1, 12.1% for MLL, and 5% for BCR/ ABL rearrangement. p16 homozygous deletions were observed in sex cases [12.7%] and hemizygous deletions in four cases [8.5%]. One case had both in two different cell populations. p16 deletions were significantly more common among T-lineage ALL [T-ALL] patients than among precursor-B ALL patients. TEL/AML1 translocations were found in seven [7/44] [15.9%]. Three out of the seven cases show culture failure and none of the remaining cases showed t [12; 21] in G-banding analysis. All those seven patients were pre-B cell lineage according to standard immunophenotyping. One patient showed the loss of one AML1 signal in addition to the TEL/AML1 fusion. MLL rearrangements [11 q23 abnormalities] was detected in 5/41 [12.1%] by combined conventional cytogenetic analysis and by FISH. Two different types of MLL gene rearrangements were observed in FISH analysis; translocation and deletion. One had split signal of the MLL gene caused by a translocation between chromosome 6 and 11 t [6; 11], detected by conventional cytogenetics. Amplification of MLL gene was observed in one case [2.27%] Four of five cases with MLL translocations showed no chromosome abnormality involving 11 q23 in Gbanding analysis. All cases with MLL gene rearrangement were pre-B cell lineage according to standard immunophenotyping. BCR/ABL rearrangement: t [9; 22] [q34; q11] was detected by conventional cytogenetic and by FISH in one case. Another one displayed BCR/ABL1 fusion signal by FISH only

Conclusion: From the results of the present study it could be concluded that, FISH analysis using DNA probes specific for p16 deletion, TEL / AML1, MLL, and BCR/ABL gene rearrangements is a powerful tool for leukemia diagnosis and risk stratification and it should be used as a routine procedure for all patients with newly diagnosed ALL

Ciculating P53 antibodies in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common malignant tumours worldwide. The poor survival after diagnosis has led to the introduction of screening programs using alpha-fetoprotein [AFP], real time ultrasound scanning and computed tomography. Unfortunately, the accuracy of these programs is limited especially in small HCCs, hence there is clearly a need for other markers of malignant changes that can be used to screen cirrhotic patients. The aim of the present study was to assess the value of using a specific ELISA for the detection of antibodies directed against p53 protein as a scneening test for early detection and characterization of HCC. The present study included 34 patients with HCC and 20 control patients with non-neoplastic chronic liver diseases admitted to Tanta University Hospital and National Liver Institute Menoufeya University. The diagnosis in all the cases was based on histopathological examination of sonar-guided liver biopsies. Tumour size and number were determined at the time of presentation by ultrasound and CT scanning, HBsAg and HCV-antibody status were determined Serum bilirubin, ALT, AST, serum albumin, prothrombin activity, and serum alpha-fetoprotein [AFP] concentrations were measured. Circulating p53 antibodies were looked for using ELISA technique specific for detection of antibodies to p53 protein in serum samples. Positivity for circulating anti-p53 was detected in 16/34 of the HCC patients but in none of the control group with a sensitivity of 47.1%, and specificity of 100%. Positivity for AFP [>500 ng/ml] was found in 14/34 of HCC cases but in none of the control group [sensitivity 41.2%, specificity 100%]. The anti-p53 positivity was not significantly correlated to AFP-positivity [p = 0.4], Screening of patients and controls by both tests increased the sensitivity of detection of HCC up to 73.5%. The positivity for anti-p53 was significantly associated with the degree of HCC differentiation. It was significantly higher in well [9/12; 75%] than in poorly differentiated tumours [7/22; 32%] [p < 0.05], but it had not any significant relation with tumour size and number, nor was it related to hepatitis B or C status, background liver diseases, age, sex, serum bilirubin, serum albumin, ALT, AST, or prothrombin activity. In conclusion, detection of anti-p53 by ELISA is convenient and may be a valuable addition to the current screening tests for HCC with the potential to detect tumours at an early, and therefore more treatable, stage