Study of the correlation between; nitric oxide profile, degree of liver injury and structural vascular changes of the gastric mucosa in chronic hepatitis C virus related liver diseases

Nitric oxide [NO] plays an important role in HCV associated hepatic dysfunction and in the pathogenesis of portal hypertension. This study was designed to correlate serum nitrite and nitrate levels with the degree of liver injury and gastric mucosal changes in HCV patients at different stages of the disease. 80 HCV infected patients were classified equally into 4 groups; chronic hepatitis C, Child A, B and C cirrhosis groups. 20 healthy subjects were allocated as a control group. For all patients, serum nitrite and nitrate levels, HCV RNA and liver test profile were evaluated. Liver biopsies for chronic hepatitis C and Child-A cirrhotic patients were obtained for grading, staging and expression of interferon gamma [INF- gamma] and pentosidine. Esophagogastrodudenoscopy to evaluate the degree of portal hypertensive gastropathy [PHG] and expression of vascular endothelial growth [VEGF] by histopathology. Serum NO profile was significantly higher in all HCV infected patients than healthy subjects. A significant correlation between IFN-gamma expression and both of serum NO and viral load. Also, hepatic pentosidine expression was correlating with staging and fibrosis. Also both of serum NO and gastric VEGF were over expressed and correlating with the degree of PHG. In HCV infected patients, serum NO was significantly overexpressed and correlating with the severity of chronic liver disease. Our study supports the role of direct viral cytopathic effect in HCV patients because of the significant correlation of viral load with both of serum NO and hepatic IFN-gamma expression. Pentosidine might be considered a marker of oxidative stress and fibrosis in chronic HCV liver disease

[Association of helicobacter pylori infection with primary open angle glaucoma]

To compare the frequency of Helicobacter pylori [H. pylori] infection in subjects with primary open angle glaucoma [POAG] vs controls. In a case-control study, 44 patients with primary open angle glaucoma and 79 patients with senile cataract [control group] were investigated for serum level of anti-H. pylori antibody using the enzyme-linked immunosorbant assay [ELISA] method. The study included 26 male and 18 female subjects with mean age of 60.8 +/- 20.6 years in the case group and 44 male and 35 female subjects with mean age of 66.0 +/- 19.8 years in the control group. Seropositivity was higher in patients with glaucoma [70.5%] compared to controls [40.5%] with an odds ratio of 3.51 [95% confidence interval, 2.89-4.11; P= 0.001]. H. pylori infection is much more prevalent in patients with primary open angle glaucoma. Further investigations are required to evaluate the possible causative role of H. pylori infection in primary open angle glaucoma

level of antibody against Chlamydia trachomatis among patients with genital infections in Mashhad

Chlamydia trachomatis is a common cause of sexually transmitted disease which can cause severe consequences. Appropriate preventive requires knowledge of epidemiology of infection in different population in order to target interventions in a cost-effective manner. In this study prevalence of C. trachomatis infections were determined according to some parameter in Mashhad. In this study serum from 76 patients with STD were examined by ELISA and IFA for C. trachomatis. Statistical evaluation was done using SPSS program. ELISA showed that 11 and 3 patients with IgG and IgM against C. trachomatis, respectively. IFA analysis showed that 1 patient had titer of 1/32, 6 patients with 1/64 and 3 patients with 1/128. One female patient showed titer of 1/256. This study provides strong evidence that Chlamydia prevalence in our region is significantly high which necessitate screening and treatment. It is, therefore, suggested that detection test for chlamydial genito-urinary infections become a routine part of STD investigations

Results of aerobic culture and antibiogram in 105 patients with acute bacterial pharyngitis

To study throat culture and antibiogram results in treatment of acute pharyngitis. 105 Patients with acute phartngitis were included in this prospective study. From all of the patients throat culture and gram-stained smear were provided. Antibiogram was done in patients with posit throat culture. 63 Patients of 105 patients [59%] gave negative throat culture and gram stained smear from pharyngeal secretions. 20 Patients [19%] have positive throat culture and gram stained smear. 12 Patients [12%] have positive throat culture and negative gram stained smear. Therefore 32 patients [31%] of 105 patients have bacterial pharyngitis. Fever, pharyngeal and tonsillar purulent exudates and adenopathy in patients with positive throat [31%] was more common than patients with negative throat cultures [69%]. The most common cause of bacterial pharyngitis was group A betahemolytic streptococcus. Antibiogram findings revealed that bacterial pharyngitis such as streptococcal, staphylococcal and pneumococcal were completely resistant penicillin, Amoxicillin and Ampicillin that are used routinely in out patient clinics, and on the other hand were sensitive to unusual antibiotics in treatment of acute bacterial pharyngitis. Including Doxycicline, Vancomycin and Erythromycin and they are better alternatives

[Accuracy of serum CRP measurement and WBC count in diagnosis of patients suspected to acute appendicitis]

Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high [15-30%] despite several techniques and investigations used to improve the diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis. This study emphasizes the impact of a normal serum C-reactive protein in reducing the rate of negative explorations. In a double blind study, blood for the WBC count and measurement of serum C-reactive protein [CRP] was collected pre-operatively from 100 patients just before going to the operating room for appendicectomy. The histopathology of the 100 appendices was grouped into positive [acute appendicitis] and negative [normal appendix]. White blood count [WBC], CRP and the histopathology finding were correlated. In-patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised [P = 0.000 and P = 0.000 respectively]. Serum CRP level was normal in 16 out of 18 negative explorations [normal appendix on histopathology]. The specificity and sensitivity of serum CRP was 88.8% and 92.6% respectively. normal pre-operative serum CRP measurement in-patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies

Urgent endoscopic sphincterotomy in acute biliary pancreatitis, an alternative to surgery

Thirty-two patients presenting with acute biliary pancreatitis were included, 20 presented early while 12 presented late after 72 hours from onset. Patients were classified using Atlanta and Ranson scoring into mild [20 patients], and 12 patients]. ERCP and urgent endoscopic sphincterotomy were done within 8 hours from admission, while patients were on supportive treatment and high dose of octreotide infusion. Sizable stones were found in 10, biliary gravel in 10, sludge in 4, inflamed papilla only in 5, fasciola fluke in 2 and an ascaris while those presented early showed complete recovery indicating the success of urgent endoscopic sphincterotomy in halting the progression of pancreatitis

Prolonged intrahepatic cholestasis in patients with schistosomal hepatic fibrosis and chronic viral hepatitis: role of associated active schistosomiasis

Among 50 patients with schistosomal hepatic fibrosis [SHF] and superimposed chronic viral hepatitis [CVH], prolonged intraheptic cholestasis [IHC] was found in 27 patients. In those patients with IHC, the frequency of active S. mansoni infection and serum levels of tumour necrosis factor-alpha [TNF-alpha] were significantly higher than in patients without jaundice [P<0.05]. After 4 courses of praziquantel [PZQ] therapy, there was a significant improvement in the clinical, biochemical and histopathological evidences of IHC in parallel with cure of active schistosomal infection and a significant decrease in serum TNF alpha levels [P<0.05]. In conclusions active S. mansoni infection with subsequent enhanced immune response is a possible etiological factor for the development of prolonged IHC in patients with SHF and superimposed CVH. Repeated course of PZQ therapy may help in the clearance of jaundice in these patients

Evaluation of zinc status as a liver function test in patients with schistosomal hepatic fibrosis

The association between schistosomiasis and Zinc [Zn] deficiency had been attributed to many causes including malabsorption, hepatic malfunction or reduction in its binding proteins [albumin and a[2] rnacroglobulins]. The present work aimed at the study of the relation between zinc status and the functional reserve capacity of the liver in patients with schistosomal hepatic fibrosis. For this purpose the study included 60 subjects; 15 healthy persons as a control group and 45 patients with schistosomal hepatic fibrosis divided into three equal groups [A, B and C] according to the severity of their liver affection using modified child's classification. It was found that zinc levels in plasma, polymorphonuclear leukocytes and erythrocytes are significantly low in all Schistosomal patients as compared to the control group and usually the more severe the dysfunction is, the more the Zn deficiency. This indicates Zn depletion in both extra and intracellular compartments can be mainly explained by the defective synthesis of plasma proteins by the liver, mainly albumin and a2 macroglobulins that act as carriers of Plasma Zn. However, the hyperzincuria found in these patients may share in the chronic Zn deficiency and it is mostly due to increased diffusible fraction of Zn as a result of hypoalbuminemia

Study of mucosal and submucosal vasculature, helicobacter pylori and protective capacity of gastric mucosa in portal hypertension

This study was conducted to assess the behaviour of mucosal and submucosal vasculature, protective capacity of gastric mucosa and the presumed aggressive factor, Helicobacter pylori in two well matched groups of patients. Group I included 40 patients with portal hypertension subdivided into: group IA, 20 patients with endoscopic evidence of portal hypertensive gas tropathy and group IB, 20 patients without gastropathy. Group II comprised of 20 control patients with gastritis, not associated with chronic liver disease or portal hypertension. Morphometric study revealed statistically significant increase in the mean value of mucosal and submucosal capillary cross sectional areas in both groups IA and IB as compared to group II, while no statistically significant difference was observed between these two subgroups, although the degree of mucosal and submucosal capillary ectasia was noticed to be more prominent in patients with gastropathy [group IA]. The biochemical studies of the gastric mucus secretion revealed a statistically significant decrease in mucin content, protein component and N-acetyl-neuraminic acid in portal hypertensive patients [group I] as compared to those of gastritis patients [group II]. Helicobacter pylori was found to be a significant aggressive factor in group II patients as compared to group I, it was present in 70% of this group, compared to 35% in group I, 45% in group IA and 25% in group IB. Thus the mechanisms of gastric mucosal changes in portal hypertension are multiple, entailing characteristically gastric mucosal and submucosal capillary ectasia, as well as decreased protective capacity of the gastric mucosa

Study of risk factor for variceal bleeding in schistosomal hepatic fibrosis patients

One hundred and twenty patients with schistosomal hepatic fibrosis and esophageal varices [mean age 34.6 + 10.6] were divided into three groups. Group I included 55 patients with past history of esophageal variceal bleeding episode [s], group II entailed 50 patients with no previous history of bleeding, and group III comprised 15 patients previously submitted to decongestion operation. 30 patients out of the group II were submitted to prophylactic sclerotherapy. Variceal bleeding occurred in 30% of the rest of this group. All patients were followed up for a mean period of 14 +/- 3.2 months [range between 8-21 months]. The most significant risk factors for occurrence of first or recurrent variceal bleeding were; increased age; low prothrombin activity, decreased platelet count, and also high modified Child's score especially in patients with past history of recurrent bleeding. Endoscopically detected factors included, large sized blue varices, with positive red color sign which was found in 90% of patients with recurrent bleeding; and in 100% of patients who bled for the first time during the study period. Increased umbilical vein diameter measured ultrasonographically was found to be an important risk factors in first time bleeders