New concept in histopathological grading and staging of chronic hepatitis C infection at Sharkia Governorate, Egypt

In this study, the Knodell histology activity index and the semi- quantitative reproducible description of the various morphological lesions of chronic hepatitis were applied on 109 liver biopsies taken from Egyptian patients infected with hepatitis C virus [HCV]. It was found that the presented histopathological features may be unusual for any of the known scoring systems. Therefore, a new system was suggested for grading and staging of liver diseases in Egyptian patients infected with HCV. Accordingly, the degrees of necro- inflammations are classified into 3 grades [1-3] and the progression of fibrosis is classified into 3 stages [1-3]. The reduced numbers of grades and stages proposed in this study may be attributed to the rapid course among Egyptians who differ in the environmental circumstances

Molecular cytogntic profiles of hepatitis C infection in patients at Sharkia Governorate, Egypt

In this study, 40 paraffin blocks liver tissues from HCV-PCR positive patients [HBV seronegative] were examined using DNA image cytometry to evaluate its role in diagnosing hepatocellular carcinoma [HCC] associated with hepatitis C virus [HCV] infection. Fluorescent in situ hybridization [FISH] technique using LSIZNF 217 chromosome 20q 13.2 probe was applied. The results showed a high percentage of S- phase fraction in cases of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA aneuploidy with a severe amplification of chromosome 20q 13.2. Consequently, DNA imaging cytometry is considered a good approach in differentiating dysplasia from well- differentiated HCC on the top of HCV infection. In conclusion, HCV has an acquired role in the development of HCC through the amplification of the aggressive tumor behavior oncogene LSIZNF 217 at chromosome 20q 13.2

Haematologial manifestations in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate the hematological manifestations occurring in patients suffering from chronic hepatitis C virus [HCV] infection. Positive HCV-RNA cases [109] were subjected to complete blood count [CBC], prothrombin time [PT], partial thromboplastin time [PTT], bleeding time [BT], coagulation time [CT], detection of fibrinogen degradation products [FDPs], measurement of plasma alpha- antitrypsin [AAT], then bone marrow [BM] aspiration and examination for 20 cases. The patients were classified into three groups according to the histopathological staging and grading of liver biopsy. The comparison between groups according to histopathological grading and staging for hematological and chemical parameters revealed a significant statistical difference in platelets count, S albumin, ALT and AST levels. The comparison between groups according to histopathological grading and staging for coagulation profile, AAT level and FDPs revealed a significant statistical difference between all parameters. Bone marrow aspiration and examination revealed mild hypocellularity with an increased number of lymphocytes and a relevance of plasmacytoid-lymphocytes

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate some immunological manifestations in chronic hepatitis C patients and to find out its relationship with liver pathology. The study included 109 positive HCV-RNA patients classified according to liver histopathology into three groups: Group I included 22 patients [G1S1], group II included 67 patients [G2S2] and group III included 20 patients [G3S3], where G = the degree of necro-inflammatory process and S = the stage of liver fibrosis. All patients were investigated for the presence of cryoglobulin, antineutrophil cytoplasmic [ANCA], anti-liver kidney microsomes [LKM], anti-double stranded DNA, [ds-DNA], anti-nuclear [ANA], anti-mitochondrial [AMA] and anti-smooth muscle [ASMA] autoantibodies. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be considered as useful prognostic indicator for the increased risk of cirrhosis in chronic HCV patients. Follow up studies were recommended

HCV and associated concomitant infections at Sharkia Governorate Egypt

This study was performed on 109 cases divided into 6 groups according to the concomitant infection with hepatitis C virus [HCV]. The results proved that groups 1, 3 and 5 had a higher level of viremia than the other groups and a higher risk was found in these groups, as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The study concluded that these factors play an important role in the progression of HCV infection. The death of the patients of this progressive condition occurs in younger age and due to liver failure more than to HCC

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt

This study included 109 patients with detectable hepatitis C virus [HCV] by real time PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathological staging and grading. The different clinical, biochemical, virological and ultrasonographic parameters were assessed and analyzed and the variables that showed a significant association with the histopathological staging and grading were included in the multivariate logistic regression analysis. The regression model revealed that platelet count, matrix metalloproteinase-9 [MMP-9], portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load added a significance to the model in a decreasing order of significance. From these findings, a new score ranged from 0-9 was generated. The score model was applied to the patients to assess its validity, where it proved to be accurate in discriminating patients with mild inflammation and fibrosis [sensitivity 81.8%, specificity 80.5% and accuracy 80.7%] and more accurate in detecting patients with cirrhosis [specificity 96.6%, sensitivity 80% and accuracy 93.6%], but less accurate in detecting patients with moderate to severe fibrosis [specificity 66.7%, sensitivity 68.7% and accuracy 67.9%]. Also, the results revealed that co-infection with schistosomiasis, old age >/45 years and positive history of blood transfusion as a source of infection were significantly associated with severe hepatic pathology

role of aflatoxin-contaminated food materials and HCV in developing hepatocellular carcinoma in Al-Sharkia Governorate, Egypt

In this study, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique revealed that corn, wheat, peanut, lupine "tennis", white rice, cowpea "lobiya", fava bean and brown rice showed a prevalence of AFB1 [64.7%, 53%, 53%, 47%, 47%, 41%, 29.4% and 29.4%, respectively]. A positive correlation was found between aflatoxin and positive HCV- PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV- infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products

Apoptosis in some chronic arthritic patients

In multicellular organisms, cellular homeostasis is maintained through a delicate balance between cell death.Physiological cell death occurs through a process of cell suicide called apoptosis. The aim of the present study was to determine the extent of apoptosis of neutrophils and lymphocytes in some chronic arthritic patients and to study its role in the pathogenesis of chronic arthritis process. The study included 27 SLE patients, 12 RA patients without joint effusion and 8 RA patient suffered from joint effusion, 13 osteoarthritic patients and 12 normal healthy subjects as control. All the studied cases were subjected to the following: full history, complete clinical examination, laboratory investigations including routine lab as C.BCs, ESR, CRP, RP, ANA. anti nDNA. and specific laboratory investigations: separation of lymphocyte and neutrophils from peripheral blood of all cases and from SF. of cases with joint effusion, detection of lymphocyte apoptosis after 48 h. of invitro culture and detection of neutrophil apoptosis at time of separation [zero hour], after 24 h. and 48 h. of invitro culture. The results were found that significant increase in apoptosis of PBL in SLE patients more than the other groups [P < 0.001], significant increase in synovial fluid lymphocyte and neutrophil at 0, 24 and 48 h. apoptosis in RA patients more than PBL apoptosis of all groups [p< 0.001]. Significant increase in synovial fluid also there was significant positive correlation between; PBL apoptosis and ESR and CRP in SLE patients but significant negative correlation between PBL apoptosis and absolute lymphocytic count in patients of SLE is found. Also, there was no significant difference in PBL, apoptosis between control and RA and OA patient [P > 0.05]. Lastly, there is no significant difference in PB neutrophil apoptosis between all groups at time of separation and after 24 h., 48 h. of invitro culture [P > 0.05]

Soluble inter-cellular adhesion molecules - 1 and T- helper and suppressor subsets in chronic hepatitis C

Hepatitis C virus [HCV], is a major cause of post transfusion hepatitis worldwide, leading to chronic liver disease. This work aimed at studying the influence of chronic hepatitis C infection on the serum level of soluble intercellular adhesion molecule-l [sICAM-1], and to study the pattern of two lymphocyte subsets, the helper I inducer [CD4.+] and the cytotoxic I suppressor [CD8+] T cells, in those patients. The study comprised 35 subjects classified into two groups: group I: included 20 patients with chronic HCV infection [15 males and 5 females], their ages ranged from 26 to 45 years. Group II: included 15 healthy controls age and sex matched with the patients group [Diagnosis of HCV infection was done by detection of HCV antibodies by 2[nd] generation ELISA and confirmed by polymerase chain reaction [PCR]]. All patients and controls were subjected to the following. investigations: Measurement of serum level of slCAM-1 by enzyme linked immuno sorbent assay [ELISA technique], immunophenotyping of peripheral blood T-lymphocytes by two colour immunofluorescence staining with monoclonal antibodies using flowcytometric analysis, C.B.C. and liver function tests.The mean serum level of slCAM-1 was significantly higher in chronic HCV patients than in normal subjects, with a significant positive correlation between serum level of sICAM-1 correlated to AST and ALT liver enzymes and percentage of CD8+ cytotoxic T cells. On the other hand, there was a negative correlation between percentage of CD4+ T helper cells and sICAM-1 serum level. The absolute lymphocyte count was significantly lower in the patients group than in the control group. The mean percentage of CD4+ T helper cells and the CD4+ T CD8+ ratio were lower in the patient group compared to the control group while the mean percentage of CD8+ cytotoxic T cells was significantly increased in the patient group than the healthy controls.From this study we can conclude that chronic HCV infection is accompanied by increased serum level of slCAM-1, increased number of CD8+ cytotoxic T cells in peripheral blood together with a decrease in CD4+ T helper cells and CD4+ T CD8+ ratio. This altered pattern in patients with chronic HCV infection could be an explanation for defective immune mechanism responsible for the chronicity of the disease, in chronic HCV patients. The results of this study suggests also that increased levels of slCAM-1 may be a valuable clinical tool in chronic hepatitis C, monitoring the severity of inflammation of liver cells and as an early detector of relapse of viral hepatitis in those patients, which deserves prospective studies

Circulating progenibors in neonates delivered of women with pregnancy induced hypertension

Neutropenia occurs often among the newborn of women with pregnancy induced hypertension but its cause and clinical consequences have not been adequately studied. To clarify the previous points 2 groups of neonates have been studied: 26 neonates of mothers with hypertensive gestation and 20 neonates of mothers with uncomplicated pregnancy. Among the neonates of hypertensive gestation, 61.5% had neutropenia, 15.38% aquired nosocomial infection and 11.53% had neutropenia and thrombocytopenia. The granulocyte - macrophage colony forming capacity of the circulating progenitors was studied in vitro in cord blood cultures of all neonates, and in peripheral blood cultures of 10 healthy adults. Sera of cord blood of neonates of hypertensive gestation and sera of their mothers were evaluated to demonstrate the presence of a humoral factor which may affect progenitor cell proliferation. The results obtained revealed a significant increase in the number of colonies yielded from cord blood in both groups of neonates in comparison to peripheral blood cultures. A highly significant decrease in the number of granulocyte - macrophage colony forming units [GM - CFUs], in the neonates of mothers with pregnancy induced hypertension compared to control neonates was found. Marked inhibition in the number of colonies yielded in the three groups studied was noticed in vitro cultures in the presence of sera of pregnancy induced hypertensive mothers and the sera of their neonates. The results reflect the presence of an inhibitor in both maternal and fetal circulation, which needs further studies for its identification. We conclude that neutropenia associated with maternal hypertension is due to reduced circulating progenitors most probably secondary to the presence of an inhibitor in maternal and fetal blood