Relation of hypoalbuminemia and liver cirrhosis to plasma tumour necrosis factor-alpha and interferon gamma among chronic active hepatitis C patients in Damanhour Medical National Institute

Tumour necrosis factor alpha [TNF-alpha] and interferon gamma [INF-gamma] are cytokines involved in natural immune responses and are important in antiviral modulation. INF-gamma is an immunostimulatory or growth-promoting factor that activates the macrophages and natural killer [NK] cells, while plasma TNF- alpha is a proinflammatory cytokine that participates with interleukine -1 [IL-1] and interleukine - 6 [IL-6] in the acute phase response and synergizes to mediate inflammation, shock and death. The World Health Organization has now recognized hepatitis C virus [HCV] as a major public health problem. The present study was conducted to assess the level of endogenous interferon [IFN-gamma] and tumor necrosis factor [TNF- alpha] to evaluate the immunological changes occurring among patients with HCV, and to study the relation of hypoalbuminemia and liver cirrhosis to plasma TNF-alpha and INF-gamma, in order to implement a nutritional care program appropriate for every patient according to his health status. The study was conducted on 2 groups of individuals. Group I comprised 40 patients infected with HCV, not treated with any antiviral medication, while group 2 comprised 20 healthy individuals who served as controls. Both groups were subjected to clinical examination, assessment of nutritional status and laboratory investigations including complete blood picture [CBC], liver function tests, plasma TNF- alpha, and IFN-gamma estimation. A significant increase in serum alanine transferase [s. ALT], Gamma giutamyl transferase [s. GGT], serum bilirubin [s. bil.], plasma INF -gamma and plasma TNF- alpha at P= 0.00. Meanwhile the levels of prothrombin activity, platelet count and s. albumin [s. aib] demonstrate a significant reduction at P= 0.00 when cirrhotic and non-cirrhotic HCV patients with or without hypoalbuminemia wee compared to controls. An inverse significant correlation was found between s. bilirubin level and plasma INF -gamma among cirrhotic patients, and between s. bilirubin level and plasma TN F- alpha, but a positive association between plasma TNF- alpha and s. alb and WBC count was found among patients with hypoaibuminemia. However, no significant correlation was detected between serum albumin and plasma TNF- alpha and plasma INF -gamma among cirrhotic or non-cirrhotic patients at P<0.00. Hypoalbuminemia and liver cirrhosis could probably affect the antiviral modular activity of plasma TNF- alpha and endogenous IFN-gamma among HCV patients

Study of prevalence of abnormal glucose tolerance in transfusion-dependent thalassemia patients

Beta Thalassemia is a chronic hemolytic anemia in which treatment by regular transfusion of packed Red blood cells [RBC] is the mainstay of patient's care. The resulting iron overload is the major cause of morbidity for these patients. Deposition of iron in the liver, endocrine glands and in the heart results in hemochromatosis in these organs. Type 2 diabetes is a common complication of iron overload. The development of diabetes in hemochromatosis is related to the magnitude of excess iron. The aim of the present work was to study the prevalence of abnormal glucose tolerance in thalassemia patients and detect whether increased echogenicity of the pancreas is correlated to the magnitude of iron excess, and to study the relation between hemosiderosis and pancreatic dysfunction. For this work, we first examined forty four patients with thalassemia major attending the Hematology Unit of Damanhour Medical National institute [DMNI]. Later on the number of patients enrolled in the study extended to ninety. Laboratory assay included fasting serum glucose level [FSG], 2 hours post prandial serum glucose level [PPSG], serum ferritin [S-Fe] and abdominal ultrasound [U/S]. The study showed that hemochromatosis was associated with increased pancreatic echogenicity and abnormal glucose level. Serum ferritin concentration and hepatitis C infection are risk factors for abnormal glucose found in transfusion-dependent thalassemia patients. Early aggressive iron chelation therapy and prevention of infections are the most important issues in managing glucose intolerance in transfusion-dependent Beta thalassemia patients

Role of leptin and obesity in male infertility

Aim: Leptin is thought to play a role in the neuroendocrine regulation of reproduction. The aim of this study was to assess the effects of obesity on the level of leptin, gonadotrophic hormones and testosterone [T] and consequently its probable fertility problems in male individuals. Subjects and Fourty obese married men were selected from the andrology clinic of the Damanhour Medical National Institute [DMNI] and were divided into two groups. Group I included 20 infertile patients. Group II included 20 fertile subjects. All men had normal growth of their genitalia and had no evidence of endocrine disease. They were subjected to estimation of body mass index [BMI], percent body fat, waist to hip ratio as indicators of the obesity state. Semen analysis and serum level of leptin, follicle - stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], and testosterone were performed in all subjects. Infertile patients were followed for one year with moderate dietary restriction and exercise. At the end of the study, the previous investigations were repeated with recording of pregnancy occurrence. Mean serum levels of LH and FSH were significantly lower in group I than in group II subjects. Indices of obesity showed a positive significant correlation with the duration of infertility as well as a negative correlation with serum LH in group I and T in group II subjects. Serum leptin showed a significant direct correlation with waist to hip ratio. At the end of the follow up period, obesity indices and mean serum leptin significantly decreased, while sperm density and motility, mean serum FSH, LH, and T significantly increased. The seven subjects who had their first pregnancy during this period had significantly lower body obesity indices with higher sperm density and LH values when compared with those who were still infertile. Conclusions: These results prove that obesity may represent an actual threat to male fertility causing decrease in sperm density, motility and gonadotrophin with hyperleptinemia. These effects are readily reversible and can be corrected with weight reduction

Blood count profile in chronic active hepatitis [C] Egyptian patients

Hepatitis C virus [HCV] is one of the most important causes of chronic hepatitis globally, and particularly in Egypt. Abnormal blood counts have been noted in clinics among patients with HCV infection. The present work is a case control study conducted in Damanhour Medical National Institute [DMNI] to evaluate the frequency and severity of peripheral blood cell abnormalities in HCV- infected Egyptian patients. Two groups of individuals were randomly selected, group 1 comprised 100 patients suffering from chronic active hepatitis C with positive RNA PCR, and group 2 comprised 100 healthy persons and represented the control group. Low neutrophil and platelet counts, but not anemia were noticed in the first group and were significantly different when compared to the control group [<2.1x10[9]/L in 27% of patients versus 10% of controls and <175x10[9]/L in patients versus 11% of controls respectively at p<0.01]. Obesity, advanced age and anti HCV seropositivity were independently associated with neutropenia, while advanced age and female gender and anti HCV seropositivity were associated with thrombocytopenia among HCV infected patients

Ramadan fasting: relation to atherogenic risk among obese muslims

Increased platelet aggregation as well as changes in coagulation factors have an important effect on the occurrence of atherogenicity and cardiovascular diseases. Fasting in general has been used in medicine for medical purposes when other measures fail. Since Ramadan fasting is different from total fasting, the present work was conducted to study the effect of Ramadan fasting on lipid pattern, some blood coagulation parameters, blood pressure and body mass index [BMI] - as atherosclerotic risk factors - in one hundred and three apparently healthy obese volunteers [15 men and 88 women] aged 15-52 years. The study comprised an initial visit for assessment V1 [before Ramadan] and three other follow up visits: V2 [at the end of Ramadan], V3 [4 weeks after Ramadan] and V4 [8 weeks after Ramadan], Targets were subjected to an interview questionnaire, complete physical and clinical examination, anthropometric measurements, dietary profile, and laboratory assay of complete blood picture [CBC], fasting serum glucose level [FSG], serum lipid pattern: total cholesterol [TC], triglycerides [TG], high density lipoproteins [HDL-c] and low density lipoprotein [LDL-c], lipoprotein a Lp [a], apolipoprotein A1 [APA], and apolipoprotein B [APB] levels; bleeding [BT] and clotting time [CT], prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen and plasma factor VII activity. Statistical analysis was performed using Chi squared, Fisher exact, Student t test, paired t test and Pearson's correlation coefficient. Statistical significance was defined at P<0.05. The study showed that by the end of Ramadan fasting, there was a significant improvement in the mean levels of hemoglobin [Hb], TC, TG, HDL-c, LDL-c, TC/HDL, LDL/HDL, Lp [a], APA, APB, PT and systolic [SBP] and diastolic blood pressure [DBP] that persisted for four weeks after fasting [P<0.05]. Ramadan fasting has not adversely affected leucocytic count or coagulation parameters [P>0.05]. There was also a significant association between dietary intake, SBP, DBP, weight, BMI, percent body fat and waist, fibrinogen and factor VII activity and TC, TG, HDL-c, LDL-c, LDL/HDL, Lp [a] and APB [P<0.05]. The model of Ramadan fasting could be followed as a behavior modification program to control or prevent atherogenicity because of its positive impact on the lipid pattern, blood count and coagulation parameters