Impact of mono or combined interferon therapy on thyroid function in chronic hepatitis C virus adult patients

Egypt has the highest prevalence of antibodies to hepatitis C virus [HCV] in the world, estimated nationally at 14.7%. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. Interferon-alpha [IFN-alpha] monotherapy or combined therapy with ribavirin is the cornerstone therapeutic agent for chronic HCV infection. Treatment with IFN may cause thyroid dysfunction. Unfortunately, the clinical approach to this toxic effect is often carried out by personal judgment rather than by defined guidelines. Indeed, clinicians often reduce the dose or sometimes discontinue IFN-alpha treatment in those patients who develop thyroid dysfunction. This may reduce the therapeutic response to this drug. Hence, this study was undertaken to evaluate the impact of INF-alpha monotherapy or combined therapy with ribavirin on thyroid function in chronic HCV adult patients of both sexes in the period from January 2009 to August 2009. Sixty adult chronic HCV patients with normal thyroid function before the start of treatment with IFN-alpha - or IFN-alpha + ribavirin were selected for the study. Of them, 7 patients discontinued treatment, 1 patient died and 5 patients could not be followed during the study period. So the number of patients enrolled in the study after 6 months was 47. Clinical examination for thyroid dysfunction as well as thyroid function tests was then carried out. The study revealed that 17 patients [36.1%] developed abnormal thyroid dysfunction. This risk increased with female gender and in combined therapy with ribavirin. The incidence of hypothyroidism was more than hyperthyroidism particularly, in patients treated with combined therapy. Given the high prevalence of HCV disease in Egypt, it is essential that physicians treating patients with IFN-alpha be aware of the clinical spectrum of thyroid dysfunction, and test for thyroid function prior to starting IFN therapy. Careful thyroid surveillance throughout the treatment period is mandatory, especially in female patients and in those receiving combined therapy with ribavirin. Moreover, patients should be informed of this risk and should be advised to tell their physicians of any related symptoms

Levels of endostatin and some angiogenic indices in both sera and pleural fluids of patients with small cell lung cancer

Angiogenesis plays an important role in growth, progression and metastasis of neoplasms. Levels of vascular endothelial growth factor [VEGF], transforming growth factor-beta1 [TGF-beta 1] and basic fibroblast growth factor [bFGF] [as angiogenic factors] and endostatin [as anti-angiogenic factor] were evaluated in sera of 30 male patients with non small cell lung cancer [NSCLC]. Their ages ranged from 36 to 70 years, average 59.3 years and 10 age and sex matched healthy controls. Pleural fluid levels of these cytokines were estimated in 18 out of 30 cancer patients as well as 10 patients with congestive heart failure pleural effusion as a control group. The present study was designed to determine whether these indices could be used as diagnostic tools for lung cancer and to evaluate their correlation to the stage of the disease. Lung cancer patients showed significant [P<0.001 and P<0.05] increased levels of the studied bioindices in both serum and pleural fluid compared with control subjects. There was no significant difference in the serum and pleural fluid levels of these cytokines between the different histological types of lung cancer. Lung cancer patients with advanced stages [n =24] showed significantly higher serum [P<0.001] levels of angiogenic factors and endostatin compared with those with early stages [n=6]. In patients with lung cancer, a significant positive correlation was found between serum levels of endostatin and each of VEGF [r = 0.58, P<0.0001], TGF-beta1 [r = 0.52, P<0.01]. and bFGF [r = 0.4, P<0.01]. A significant positive correlation between serum VEGF and TGF-beta1 [r = 0.45, P<0. 01] was found in patients with advanced lung cancer. Regarding Pleural effusion, there were significant positive correlations between levels of endostatin and each of VEGF [r = 0.44, P<0.0001], TGF-beta 1 [r = 0.43, P<0.01] and bFGF [r = 0.46, P<0.01]. Similarly, a significant positive correlation between VEGF and TGF-beta 1 [r = 0.45, P<0.01] was found. In conclusion: measurement of VEGF, TGF-beta 1 and bFGF [as angiogenic factors] and endostatin [as anti-angiogenic factor] could be used as tumor markers in NSCLC. Their serum and pleural fluid levels are correlated to disease severity rather than its pathological types. The endogenous pro- and anti-angiogenic factors reveal the complexity of the homeostatic system controlling angiogenesis. Further studies are recommended to follow up these factors in different clinical states and correlate their levels with prognosis

Role of zinc in hepato- and nephrotoxic effects of chlorpyrifos. A biochemical, trace elemental and histological study

Chlorpyrifos [CPF] is one of the most potent broad-spectrum organophosphates used frequently against cockroaches and other structural pests. Repeated exposure to chlorpyrifos may endanger many populations with resultant toxic effects on many organs. Recent studies revealed that zinc might modulate these toxic effects. This work was carried out to ascertain the toxic effects of CPF on the rat liver and kidney. Also, the possible protective role of zinc had been evaluated. The study was conducted on 70 adult male albino rats divided into seven equal groups. Group I: negative control, group II: distilled water, group III: zinc, group IV: low dose CPF, group V: high dose CPF, group VI: zinc and low dose CPF and group VII: zinc and high dose CPF. The duration of the study was eight weeks then hepatic, renal profiles, plasma zinc, copper, MDA, SOD, GSH, GSSO were measured. Also, histological examination of liver and kidney was done. The obtained biochemical and histological results revealed hepatic and renal toxic effects induced by CPF in a dose dependent manner. Zinc supplementation resulted in a remarkable protective effect at the biochemical and histological levels. Further studies on zinc supplementation to either patients or workers exposed to CPF are recommended

Protective effect of thymus extract against stress-induced gastric ulcer in rats

This study was conducted to investigate the protective effect of thymus extract against peptic ulcer in stress-induced gastric ulcer model in rats, together with the determination of its effect on gastric secretion. The possible effect of thymus extract on the isolated fundal strip of rat stomach and the isolated smooth muscle of guinea pig ileum was also studied. The oral administration of thymus extract [50 mg/kg/day] for one week significantly reduced the incidence of ulceration, the mean ulcer score and the ulcer index compared with the saline control group and achieved a preventive index of 57%. Also, it decreased gastric acidity, as it significantly reduced the mean pepsin concentration as compared with the saline control animals. On the other hand, thymus extract produced a dose- dependent relaxant effect on the isolated smooth muscle of guinea pig ileum, but not the isolated fundal strip of rat stomach

Field evaluation of latex agglutination test for detecting urinary antigens in visceral leishmaniasis in Sudan

A latex agglutination test to detect urinary antigens for visceral leishmaniasis [VL] was studied. In 204 patients with suspected VL, KAtex had a sensitivity of 95.2% with good agreement with microscopy smears but poor agreement with 4 different serology tests. It was also positive in 2 confirmed VL cases co-infected with HIV. In all KAtex-positive confirmed cases actively followed up after treatment, the test became negative 1 month after completion of treatment. While KAtex had a specificity of 100% in healthy endemic and non-endemic controls, the direct agglutination test [DAT] was positive in 14% of the KAtex-negative healthy endemic controls. KAtex is a simple addition to the diagnostics of VL particularly at field level and as a complementary test for the diagnosis of VL in smear-negative cases with positive DAT results

Possible interactions between gentamicin, cefotaxime, ofloxacin and metronidazole with some non-depolarizing neuromuscular blocking drugs on rat phrenic nerve-hemidiaphragm preparation

The present study was conducted to investigate the neuromuscular blocking activity for gentamicin, cefotaxime, ofloxacin and metronidazole and the possible interaction with the nondepolarizing neuromuscular blockers; atracurium, rocuronium and vecuronium, using the rat phrenic nerve-hemidiaphragm preparation. Gentamicin and cefotaxime exerted concentration dependent neuromuscular blocking activities on the rat phrenic nerve-hemidiaphragm preparation. Also, they potentiated significantly the neuromuscular blocking activity of the used neuromuscular blocking agents, atracurium, rocuronium and vecuronium at most of the used concentrations. On the other hand, ofloxacin and metronidazole had no effect on the rat phrenic nerve hemidiaphragm preparation when used alone or with the used neuromuscular blockers. It was concluded that anesthesiologists should be aware of the neuromuscular blocking activity of gentamicin and cefotaxime when used perioperatively. Also, the use of ofloxacin and metronidazole, which appears to be safe and does not affect the action of neuromuscular blockers, still needs further investigations

Potential protective effect of L-Arginine on cyclosporine A induced osteopenia in adult albino rats

This study aimed to assess the possible toxic effect of cyclosporine A [CsA] on bone and the potential protective effect of L-arginine on CsA-induced osteopenia. The study was conducted on 120 adult male albino rats divided into eight equal groups: Group I [negative control], group II [distilled water], group III [corn oil], group IV [L-arginine, low dose], group V [L-arginine, high dose], group VI [CsA], group VII [L-arginine, low dose + CsA] and group VIII [L- arginine, high dose + CsA]. The duration of the study was six weeks, then the level of urinary deoxypyridinoline [Dpd] and N- terminal telopeptide [NTx] [markers of bone resorption], serum calcium, osteocalcin and bone specific alkaline phosphatase [BSALP] [markers of bone formation] were measured. Also, bone mineral density [BMD] of spine using dual energy X-ray absorptiometry [DEXA] was measured. The results showed that CsA had an osteopenic effect and L-arginine provoked a significant protective effect

Some of the toxic responses accompanying both short and long term administration of mycophenolate mofetil in adult albino rats

Some of the toxic hazards associated with short- and long-term administration of mycophenolate mofetil [Cellcept] were evaluated in this study. It was conducted on 36 adult albino rats of both sexes [180 +/- 20 g body weight]. They were divided into four main groups: A negative control group [group I], positive control groups [IIa and IIb] received distilled water orally and Cellcept groups [III and IV] received Cellcept 72 mg/day and 36 mg/day orally for one and three months, respectively. At the end of the study, blood samples were collected for the determination of Hb concentration, red blood cells count [RBCs], white blood cells count [WBCs] and platelets counts, blood urea nitrogen [BUN], serum creatinine, uric acid, potassium [K+], sodium [Na+] and calcium [Ca++] levels. Furthermore, a histopathological examination of the small intestine and the kidneys was carried out

Failed back surgery syndrome after lumbar diskectomy

Thirty-two patients with failed back surgery syndrome after lumbar discectomy were studied clinically and radiologically to determine factors causing the failure. In this study we found that the recurrence or persistence of low back symptoms were due to disc reherniation in two cases, disc herniation at another level in four cases, operation at wrong level is three cases, epidural scarring and spinal spenosis in ten cases, disc space infection in two cases, arachnoiditis in six cases, mechanical instability in three cases and exaggeration of degenerative changes in two cases

role of CT scanning in the diagnosis of acetabular fractures

Twenty-two patients with acetabular fracture were examined by computed tomography [CT]. Traditional classification into anterior column, posterior column, and complex two - column fractures was facilitated. CT was especially useful in evaluation of the fractures is which unique information concerning the configuration of the fracture, integrity of the acetabular roof and quadrilateral surface. CT was also useful in determination of presence or absence of loose bodies in the joint and in evaluation of the femoral head and sacroiliac joint in all types of fractures

Magnetic resonance imaging of the knee in diagnosis of meniscal tears

Retrospective analysis of thin section. High resolution magnetic resonance images of the knee joint. Produced using a solenoid surface coil. Indicates that MR imaging is an effective technique for evaluating meniscal injuries. Images of 24 patients were evaluated and the results were correlated with those of subsequent arthroscopy and or arthrotomy. The sensitivity. Specificity and accuracy of MRI were respectively, 79.9, 81.8 and 79% for tears of the medial meniscus. 80, 84 and 87% for tears of the lateral meniscus

Correction of hallux valgus by modified Hohmann's osteotomy

Modified Hohmann's osteotomy had been done for hallux valgus in 32 feet [22 patients]. Postoperatively all 22patients had complete relief of pain, all but three were satisfied with cosmetic results. Twelve feet developed asymptomatic callosities under the second and third metatarsal heads. Late complications included recurrent hallux valgus, stiffness and pain in the first metatarsophalageal joint, and metatarsalgia of the second third and fourth metatarsal heads in four cases

Entrapment neuropathy of the suprascapular nerve

Five patients were found to have suprascapular entrapment, diagnosed by clinical and electromyographic findings. A positive EMG including a delayed nerve condition is necessary confirming evidence of the need for surgical treatment. Hypertrophy of the transverse scapular ligament was found to be the cause in three cases and its release gave one excellent and two good results. A ganglion in the spinoglenoid fossa was the cause of entrapment of the lower branch of the suprascapular nerve in two cases and its excision along its pedicle gave excellent results

Immunoglobulin changes in chronic staphylococcal osteomyelitis

Of 75 patients of chronic osteomyelitis, 50 patients showed Staphylococcus aureus as the causative organism. The Rose Waaler slide test, the antinuclear factor and the serum globulins levels [IgG, IgM, IgA] were estimated for these fifty patients and for fifty control subjects of the same age and sex. All the patients and control subjects showed a negative Rose Waaler test and no antinuclear factor was detected. The serum level of IgG elevated in these cases to a statistically highly significant level in comparison with the controls. IgA levels showed a significant rise, while IgM levels showed no significant difference. There was no significant difference between immunoglobulin levels of males and females. Furthermore, there was no correlation between immunoglobulin levels with the age of the patients

Conventional myelography and CT scanning in diagnosis of brachial plexus traction injuries

Fifteen patients of traction injury of the brachial plexus were investigated clinically, by myelography and C.T. Scanning of the cervical spine. In 5 cases, the results of C.T. Scanning of the cervical spine and conventional myelography were compared with surgical exploration of the plexus. C.T. scanning with contrast was found to be more accurate than the conventional myelography in diagnosis of traction injury of the brachial plexus

Displaced fractures of the proximal end of the humerus

Thirty five proximal humeral fractures were reviewed in relation to the Neer classification and the treatment given. Twenty-two cases were - treated conservatively and thirteen cases were treated surgically by open reduction and internal fixation by AO buttress plate in 7 cases and by K-wire and screws in 5 cases and by arthrodesis in one neglected case. In the displaced two-part fractures and fracture dislocation there was no significant difference in the results between the surgical and the conservative groups. Closed treatment gave satisfactory results in the three part fractures [5 cases] but not in the four part fractures [6 cases]. Dislocated-fractures of the humeral head should be treated by means of osteosynthesis. In younger patients osteosynthesis by T-shaped buttress plate has been used as the method of choice. In older patients open reduction and K wires fixation could be used

Ultrasonography of rotator cuff tear

This study included twenty six patients suspected to have rotator cuff tear. Ultrasonography was done for all patients after full clinical and radiological evaluation. It has been proved that ultrasonography is a rapid and non-invasive mean of diagnosing rotator cuff tears, the technique is simple and the anatomy is straightforward in most cases