Early parenteral supplementation with glutamine dipeptide for acute myeloid leukaemia patients receiving high dose chemotherapy

Background: Glutamine dipeptide [Gln] is one of conditionally essential amino acids that have a crucial role in cancer

Objectives: The aim of this study was to investigate the effects of early Gln supplementation in patients with acute myeloid leukemia [AML] receiving intensive chemotherapy, but without bone marrow transplant and regardless of receiving parenteral nutrition

Methods: A randomized control trial was carried out and included 46 AML patients who received high dose chemotherapy. Their ages ranged between 17-65 years. AML patients were randomly allocated as intervention group [Gln group; n=23] and control group [n=23]. Gln group received intravenous supplementation with Gln [40 gm] from day 1 to day 5 of chemotherapy, while the patients in the control group received 40 gm per day of a standard amino acid mixture. Clinical end points included the body weight, body mass index, length of hospital stay, days of neutropenia, superoxide anion generation and length of neutropenic fever and serum albumin difference. White blood cells and absolute neutrophil count were done every second day till ANC reached >500microl then superoxide anion generation was measured

Results: Weight loss, length of hospital stay, the mean days of neutropenia and neutropenic fever were significantly lower in the Gln group, whereas the mean superoxide anion generation was found higher comparing to the control group [50 ng/L vs 43ng/L respectively]. Complications other than febrile neutropenia were significantly less common in Gln group. Gln supplementation has resulted in significant improvement in serum total protein and serum albumin

Conclusion: This trial suggested that early Gln supplementation regardless receiving parenteral nutrition enhances neutrophil function, maintains nutritional status and decreases hospital stay

Circulating apolipoprotein alpha1, haptoglobin and alpha2 macroglobulin as fibrosis markers in chronic hepatitis c patients

Hepatitis C virus [HCV] infection is one of the commonest chronic liver diseases worldwide. Progression to chronic disease occurs in the majority of HCV infected patients. The aim of the present work was to study serum levels of alpha2 macroglobulin [alpha2-MG], Apolipoprotein A1 [Apo-1] and Haptoglobin [HP] as non-invasive index of the presence of cirrhosis in chronic hepatitis C patients in relation to the histopathological findings. The study was carried out on 20 patients with chronic HCV and liver cirrhosis [Group I], 20 patients with chronic HCV without liver cirrhosis [Group II] and 10 healthy subjects of mathing age and sex as controls [Group III]. Quantitative estimation of alpha2-MG, HP and Apo AI in serum was done using turbidimetry. The mean serum level of alpha2-MG was significantly higher in group I than in groups II, III [F=12.8] [p=0.00]. On the other hand, Serum Apo A1 and HP were significantly lower in group I than in groups II, III [F=5.9 and 26.3] [p=0.005 and 0.00]. On the other hand, no significant difference was found between groups II and III. Significant positive correlation was observed between serum alpha2-macroglobulin and Child Pugh score, Grading and staging of liver pathology [P<0.05]. On the other hand, significant negative correlation was noticed between serum Apo-1, HP and Child Pugh score, histopathological grading and staging [P<0.05]. Elevated serum levels of alpha2 macroglobulin in addition to low levels of apolipoprotein A1 and haptoglobin might be considered as valuable non invasive parameters for predicting the occurrence of cirrhosis in chronic hepatitis C patients

Clinical significance of plasma homocysteine concentration in chronic hepatitis C patients with liver cirrhosis

Homocysteine [Hcy] is a sulfur containing amino acid that is formed as an intermediate in methionine metabolism. Extensive evidence shows that hyperhomocysteinemia is considered an independent risk factor for atherothrombotic vascular disease. Methionine metabolism occurs mostly in the liver. Altered methionine metabolism, in advanced liver disease, may play a pathogenic role. The aim of this work was to evaluate the clinical significance of plasma Hcy concentration in chronic hepatitis C patients with liver cirrhosis. Twenty male patients [mean age 43.13 +/- 7.02 year] with chronic hepatitis C with liver cirrhosis [Group I] and 10 healthy age-matched control subjects [Group II] were included into the study. Ten patients with liver cirrhosis were diagnosed with hepatorenal syndrome [HRS] [Group Ia] and 10 did not have FIRS, Liver function, renal function tests, urinalysis, HCV Ab, HCV-PCR, plasma folate, B12 and Hcy concentration, abdominal ultrasound were performed for all studied subjects. Plasma Hcy concentration was significantly elevated in cirrhotic patients compared to healthy controls [P<0.05]. Hcy was positively correlated with the severity of liver disease as expressed by the Child score [P<0.05]. Plasma Hcy concentration was significantly higher in patients with HRS than in patients without HRS [P<0.05], and inversely correlated with the creatinine clearance rate [P<0.05]. There was no significant difference in folate and B12 levels between patients and controls. Plasma Hcy is elevated in patients with chronic hepatitis C and liver cirrhosis, and correlated with the progression of liver disease, Patients with cirrhosis complicated with HRS have higher Hcy concentration compared to patients with normal renal functions, and Hcy level increases with the deterioration of renal function

effect of chronic exposure to organophosphorous insecticides on apoptosis in patients with liver diseases

The rapidly increasing use of organophosphorous compounds in everyday life obligate that greater attention should be paid to the toxic effect exerted by these compounds of human organism. To investigate the effect of chronic exposure to organophosphorous insecticides on liver at chronic hepatitis C virus infection and the chance of development to hepatocellular carcinoma, through studying apoptosis by the measurements of soluble Fas. This study was carried out on sixty subjects; they were divided into six groups: The first control group composed of 10 healthy subjects. The second group composed of ten patients with hepatocellular carcinoma associated with chronic hepatitis C virus and chronic exposure to organophosphorous. The third group composed of ten patients with hepatocellular carcinoma associated with chronic hepatitis C virus. The fourth group composed of ten patients with chronic hepatitis C virus and chronic exposure to organophosphorous. The fifth group composed of ten patients with chronic hepatitis C virus. The sixth group composed of ten patients with chronic exposure to organophosphorous. The time of exposure to organophosphorous was chosen to be over than 10 years. For all groups we do the following investigation: Detection of anti-HCV and HbsAg by ELISA technique, quantitative determination of HCV RNA by real time PCR, estimation of serum levels of bilirubin; albumin level and serum activities of aspartate and alanine aminotransferase; gamma glutamyl transferase activity [GOT]; and prothrombin time, determination of paraoxonase [PON] activity, and determination of sFas by ELISA. All patients show hyperactivity of AST, ALT, and GOT, hypoactivity of PON and high level of sFas. Chronic exposures to organophosphorous giving a high chance to the development of hepatocellular carcinoma by decreasing apoptosis and this risk is further exaggerated by the presence of previous chronic hepatic inflammation as chronic HCV

Serum soluble transferrin receptors in patients with chronic hepatitis C

Recently, it has been found that iron is an important element in the natural history of hepatitis C. Serum markers of iron stores are frequently increased in chronic hepatitis C infected patients and therefore, detection of soluble transferrin receptor[sTfR] may allows for quantitative evaluation of intracellular iron. The aim of the present study was to study serum levels of soluble transferrin receptors in patients with chronic HCV. The study was carried out on 40 patients classified into three groups. Group I enrolled 10 chronic HCV with high serum iron and ferritin, Group II included 10 patients with chronic HCV with normal serum iron and ferritin [Both groups I, and II had no cirrhosis], Group III compromised of2O patients with chronic HCV and liver cirrhosis. Also 10 healthy subjects were taken as control. Soluble transferrin receptors were measured in patient sera using humans TJJ? ELISA Kit. The mean serum sTfR was significantly lower in group III than in groups I, II and IV. Also, it was significantly lower in group I than in groups II and IV On the other hand, no significant difference was found between groups II and IV. Correlation study revealed significant negative correlation between serum sTfR and serum iron and ferritin in groups L II and III. Moreover, in group III significant negative correlation was noticed between serum sTfR and staging [r0.83, 0.00]. sTfR can be regarded as a valuable and specific tool for investigating tissue iron that can be used to predict the degree of hepatocellular damage and progression into advanced fibrosis and subsequent cirrhosis

Study of the serum level of Interleukin-IS (IL-18) in patients with chronic hepatitis C virus infection

Background: One of the most important factors affecting HCV pathogenesis are cytokines. Up till now most of the researches revealed enhanced hepatic expression of the Th1 cytokines in individuals with chronic HCV. However this is not enough to explain the pathogenesis of HCV. Therefore, studying of more advanced mechanisms of recently discovered cytokines may be helpful in solving this problem

Objective: The aim of the present work was to study the serum level of IL-18 in patients with chronic hepatitis C. Virus infection with and without liver cirrhosis and in hepatocellular carcinoma

Methods: The study was conducted on fifty subjects classified into four groups Group I: included twenty patients with chronic HCV virus infection without liver cirrhosis. Group II: enrolled ten patients with chronic HC V virus infection with liver cirrhosis. Group III: compromised of ten patients with hepatocellular carcinoma on top of chronic HCV, Group IV: ten healthy subjects with matching age and sex were enrolled as controls. IL-18 was measured in serum by ELISA

Results: Mean Serum IL-18 [pg/ml], were 383.12 +/- 87.93 , 710.5 +/- 212.92, 836.5 +/- 116.83 and 197 +/- 14.37 pg/ml in the four groups respectively The results revealed that serum IL-18 increased significantly in patients with hepatocellular carcinoma more than chronic HC V patients [ with and without cirrhosis]. Moreover, patients with cirrhosis had significantly higher levels of serum IL-18 than in non-cirrhotics and controls. A positive correlation was found between serum IL-18 and Child Pugh scoring in groups II and 111 patients [r = 0.86, 0.94 respectively] [p = 0.00 in both groups], as well as with histopathological [necroinflammatory] grading in groups I and II [r=0.82, 0.98 respectively ][ p=0. 00]

Conclusions: From the previous results we can conclude that IL-18 is involved in the activity of the disease process and might have a prognostic value in the progression of liver cirrhosis and HCC

Chlamydia pneumoniae antibody titers in asthmatic children; relation to asthma severity and the dose of inhaled steroids used for control

Accumulating evidence suggests that Chlamydia pneumoniae [C. pneumoniae], an intracellular ubiquitous pathogen with an innate propensity to persist and cause chronic infections, may be associated chronic inflammation in asthma. As inflammation has been found to be present in almost all asthmatics, inhaled steroids now, have an established position in the treatment of persistent asthma. However, corticosteroids negatively affect many aspects of cell-mediated immunity and deteriorate the host's ability to eradicate an intracellular pathogen, such as C. pneumoniae. The aim of this work was to investigate the relationship between C. pneumoniae infection and asthma severity as well as the doses of inhaled steroids used for asthma control. An enzyme immunoassay was used to measure the immunoglobulin [Ig] G and IgA antibodies against C. pneumoniae in a study group consisting of 100 asthmatic children with different grades of asthma severity on regular prophylactic inhaled steroids, and 50 non-asthmatic age and sex matched healthy controls. Statistical analysis of the results showed: [A]- No significant difference in the mean IgG [t=0.923, P=0.358], and IgA [t=1.233, P=0.22] antibody titers between asthmatic and non-asthmatic children. [B]- In asthmatic children, we found the following: [1]- The mean IgG and IgA antibody levels were significantly higher in patients with severe asthma than in patients with mild and moderate asthma [IgG: F=197.4, P<0.01and IgA: F= 4.67, P<0.05]. [2]- A significant positive correlation between C. pneumoniae IgG and lgA antibody titers and asthma severity [IgG: r=0.901, P<0.01; IgA: r=0.847, P<0.01], and the frequency of exacerbations [IgG: r=0.866, p<0.01; IgA: r=0.859, P<0.01]. [3]- A significant negative correlation between the IgG and IgA antibody titers and peak expiratory flow rate [IgG: r=0.641, P<0.01 and IgA: r=0.859, p<0.01]. [4]- A significant positive correlation between the IgG and IgA antibody levels and the mean dose of inhaled steroids used for control [IgG: r=0.861, P<0.01 and IgA: r=0.806, P<0.01]

Conclusions: our results suggest that C. pneumoniae may act by flaring up inflammation in asthmatics rather than by initiating the disease, and that the higher intensity of C. pneumoniae infection in asthmatics may be associated with more severe airway inflammation and higher doses of inhaled steroids used for control

Etiology of nephrocalcinosis in infants and Children

Nephrocalcinosis [NC] is the deposition of calcium and oxalate or phosphate in the renal tubules, tubular epithelium or renal interstitial tissue. It is being recognized more frequently since the introduction of ultra sonographic imaging. The sonographic appearance of NC is characterized by presence of echo- dense deposits in renal medulla, cortex or both. This study was conducted to define the underlying etiology of NC in Egyptian infants and children. Thirty two cases with NC were studied in Alexandria University Children's Hospital during the period [January 2001 to January 2004]. The ages of studied cases varied between I month and 9 years with male to female ratio of 1:3:1. Mean age at diagnosis was 2.8 +/- 2.7 years. Thorough clinical, imaging and metabolic evaluations were done to all cases. Sonographic evidences of bilateral medullary NC were evident in 87.5% of cases, combined medullary and cortical NC occurred in 9.4 % of cases, while cortical NC was found in only one case [3.13%]. Abdominal X-ray detected NC in only 34.4% of patients. Clinical presentations of NC were polyuria, polydipsia or dehydration in 62.5%, metabolic acidosis in 53%, urinary tract infection in 47%, psychomotor retardation [44%] failure to thrive [37.5%], abdominal or loin pain [31%], gross or microscopic hematuria [25%] and spontaneous passage of stones [12.5%]. Nephrolithiasis was associated with NC in 79% of the cases. Family history of renal stones was reported in 25% of cases compared to 10% in controls. , , Infants with NC [group I] had normal anion gap [AG], increased mean serum levels of calcium [Ca] and I chloride and decreased mean level of blood pH but without reaching statistical significance. Serum ; potassium, HCO3, urinary specific gravity [SG], citrate/creatinine and magnesium/ creatinine ratios were significantly reduced in group I, while urinary pH and Calcreatinine ratio were significantly elevated [p= 0.02,0.001 respectively]. Infant mortality was 41.2% due to recurrent sepsis. Blood urea, creatinine [Cr] and AG were high in patients older than one year of age [groups II and III], while HCO3 and Cr clearance were significantly lower than the control values [p<0.005]. Serum uric acid in cases older than 5 years [group III] was significantly higher than the control group. Urinary 24 hour calcium and oxalate output were significantly high in groups II and III [p=0.0001, 0.02 respectively] while urinary output of citrate, magnesium and phosphate were significantly lower in these cases compared to controls [p<0.005]. , Nephrocalcinosis was due to metabolic diseases in 75% of the cases and due to iatrogenic hypervitaminosis D [HVD] in 25%. Metabolic errors were distal renal tubular acidosis [RTA-I] in 37.5%, renal idiopathic hypercalciuria [IHC] in 25% and primary hyperoxaluria [PHyOx] in 12.5%. Hypercalciuria ' was the commonest urinary abnormality detected in 87.5% of cases, being due to RTA-I in 42%, IHC in I 29% and HVD in 29%. Hyperoxaluria was present in 723% of cases due to PHyOx. Hypocitraturia and hypomagnesuria were found in 75% and 66%of cases respectively. Etiology of NC in infants was RTA-I in 64.7% and HVD in 35.3%. The commonest cause sf NC in cases > 1 year of age was IHC [53%]. None of the studied cases showed resolution of NC during the years of follow-up [1.8 +/- 0.9 years]

Conclusions: the diagnosis of NC requires a thorough evaluation to identify the underlying offending factor. Different etiological factors may interplay to produce NC; but metabolic errors played the major role in the current study [75%], while iatrogenic HVD was responsible for 25% of the cases. The metabolic causes of NC were RTA-I, IHC and PHyOx. Hypercalciuria was the most common urinary abnormality detected in 87.5% of cases. The deficiency of the urinary calcium crystallization inhibitors manifested by hypocitraturia in 75%of cases and hypomagnesuria in 66% were associated possibly contributing risk factors in most of the cases. Ultrasonography is superior to abdominal X-ray and CT in early detection of NC

Serum aluminum level and its relation to serum trace elements in children with attention deficit hyperactivity disorders

Attention deficit hyperactivity disorder [ADHD] is the most common neurobehavioral disorder of childhood. Despite this disorder is increasing in prevalence, it is still controversial and its etiology is not fully known. There is increasing awareness of the role that metals1 minerals play in health and disease. Aluminum is one of the most abundant metals in the environment. It contributes very significantly to nervous diseases by affecting diverse functions, so a clear need exists for active work on the environmental causes of ADHD. This motivated us to carry out this research to find the possible role of aluminum in ADHD and its effect on the level of essential trace elements known to affect behavior and attention in children [iron, zinc and copper]. This study was conducted on twenty children [12 boys and 8 girls] aged 4-8 years diagnosed with attention deficit hyperactivity disorder according to DSM-IV criteria. Twenty age and sex matched normal children were included in the study as control group. All were subjected to psychometric assessment using Conner's rating scale and standard cognitive assessment intelligence scale. Serum aluminum, calcium, iron, zinc, and copper were measured using spectrophotometric techniques. The results proved that patients with ADHD showed statistically highly significant increase in serum levels of aluminum [p= 0.002] and significant lowering of serum calcium [p= <0.001], iron [p= <0.001], and zinc [p=0.01] as compared to controls. Serum levels of copper were lower in ADHD children than controls but the difference was not statistically significant [p=0, 29]. Correlation between studied variables revealed significant proportional correlation between Conner's rating score and serum levels of aluminum and significant inverse correlation between it and serum levels of calcium, iron and zinc. As regards IQ, there was inverse correlation between serum aluminum and total, verbal and performance IQ score and there was significant direct correlation between serum zinc levels and total, verbal and performance IQ. Serum levels of iron were proportionally correlated to both verbal and performance score while calcium was correlated to performance score only. When correlating serum levels of aluminum with calcium and studied trace elements levels, serum aluminum levels were inversely correlated to serum levels of iron, calcium, and zinc. There was no significant correlation between serum levels of aluminum and serum levels of copper. Mean serum level of aluminum was significantly higher in those patients living in industrial areas as compared to those living in non-industrial areas

Conclusions and Recommendations: in the light of present study, we can postulate the significance of increased levels of aluminum in etiopathogenesis of ADHD. The significance of these findings for children health requires better understanding of the amount and bioavailability of aluminum in food, air, drinking water, and medications and from sources unique to infants and children such as vaccination. Exposure to aluminum should be monitored and limited as far as possible and this needs multidisciplinary collaborative research efforts

Assessment of free and total testosterone serum levels in mild and severe preeclamptic patients in the third trimester of pregnancy

Objectives: The objective of this work was to determine the value of maternal serum potent androgen levels, namely total and free testosterone in relation to the severity of preeclampsia

Subjects and Methods: The study was carried out on sixty pregnant women, twenty of them had mild preeclampsia [group I], twenty were cases of severe preeclampsia [group II], and twenty normotensive pregnant females acting as a control group [group III] and matched with the other two groups as regards gravidity, age, body mass index, and gestational age. All cases were subjected to a thorough history taking, a full clinical examination, an ultrasonographic examination and umbilical artery Doppler evaluation. In all cases serum creatinine, serum uric acid, serum liver enzymes, 24 hour protein in urine, and platelet count were measured using standard techniques. Total and free testosterone levels were measured in sera of all patients using electrochemiluminescence immunoassay, and enzyme linked immunoassay respectively

Results: A significant increase in serum uric acid, creatinine, liver enzymes, and decrease in platelet were found in patients with mild and severe preeclampsia in comparison to normotensive pregnant females. Furthermore, group II cases had statistically significant higher level of serum uric acid, serum creatinine, and serum liver enzymes and also had a significantly lower platelet count in comparison to group I. A significant increase in total and free serum testosterone level was found in patients in group I [1.27 +/- 0.39 ng/ml for total and 1.577 +/- 0.736 pg/ml for free testosterone] and in group II [1.82 +/- 0.46 ng/ml for total and 3.779+/-1.626 pg/ml for free testosterone compared to group III [0.61 +/-. 0.26 ng/ml for total and 0.458 +/- 0.245 pg/ml for free testosterone]. Furthermore, group II cases had statistically significant higher total testosterone serum levels than group I cases [P =0.000]

Conclusions: Potent serum androgens namely free and total testosterone are elevated in preeclampsia, and their levels are related to the severity of preeclampsia

relationship between serum lipids and pelvic endometriosis

Endometriosis is a disease characterized by the presence and growth of ectopic endometrium outside the endometrial cavity. Laparoscopy is the most effective tool in the diagnosis and treatment of endometriosis and in evaluation of women with chronic pelvic pain. Other diagnostic procedures include ultrasonography, hysterosalpingography, CT scan, Magnetic resonance image and CA-125 level as non invasive methods. Lipoprotein [a] level is elevated in cases with endometriosis. Sex hormones and gonadal steroids have been reported to influence the metabolism of lipoproteins and lipids. The aim of our study was to evaluate the relationship and diagnostic value of serum lipids in cases of pelvic endometriosis. Forty patients have been chosen from the outpatient clinic of the Shatby Hospital, they were classified into three groups. Al patients were subjected to thorough history taking, clinical examination and routine investigations, laparoscopic examination were done, blood samples were collected to measure serum lipids and lipoproteins. Serum lipoprotein [a] levels were about one and half fold higher in women with endometriosis than in control group. The accuracy of lipoprotein [a] in diagnosis of endometriosis is 60%. So, we cannot depend on it alone as a non invasive tool in the diagnosis of endometriosis

Study of some parameters of infection of ascitic fluid in patients with liver cirrhosis

Spontaneous bacterial peritonitis [SBP] is one of the most serious complications of ascites in patients with liver cirrhosis. The aim of this study was to investigate the role of ascitic fluid fibronectin, C3 and C4 in patients with liver cirrhosis and ascites. The study was carried out on thirty patients with ascites classified into three groups, group I; 10 patients with SBP, group II; 10 patients with ascites and ascitic fluid total protein more than 1.5 gm/dl and group III: 10 patients with ascitic fluid total protein less than 1.5gm/dl. C3 and C4 were measured by nephelometery while fibronectin was measured by radial-immunodiffusion. The mean values of fibronectin [mg/dl] in groups I, I and III were 56.90 +/- 11.29, 78.50 +/- 15.99 and 60.70 +/- 5.86 respectively, C3 [mg/dl] 11.6 +/- 2.87, 22.8 +/- 8.39 and 16.9 +/- 1.28 respectively and C4 [mg/dl] 4.27 +/- 2.13, 7.4 +/- 2.22 and 5.3 +/- 0.3 respectively. There was significant positive correlation between fibronectin in ascitic fluid and C3 and C4 as well as between fibronectin and ascitic fluid total protein. Fibronectin in ascitic fluid can be used as a biochemical risk factor indicator of spontaneous bacterial peritonitis

Study of some prothrombotic causes in patients with chronic deep vein thrombosis in Alexandria

Venous thromboembolism is a serious medical problem causing considerable suffering and occasional death. In this study a search for the presence of some causes of prothrombotic states such as deficiency of protein C, protein S and anti-thrombin III [ATIII], and the presence of activated protein C resistance [APCR] and anti-cardiolipin antibodies was done in patients with chronic deep vein thrombosis [CDVT] in Alexandria. The study included 30 patients with CDVT, 20 females and 10 males with a mean age of 41.35 +/- 12.2 years and the results were compared with those of 20 healthy subjects of matched age and sex. The results showed that APCR defined as normalized activated protein C resistance ratio [n-APCR-ratio<0.8] was found in 23.3%, ATIII deficiency in 23.3%, Protein S deficiency in 10%, and protein C deficiency in 3.3% of the patients while anti-cardiolipin antibodies expressed as > 10 GPL unites for IgG and > 7 MPL unites for IgM were detected in 20% of the patients. These results revealed that APCR and ATIII deficiency are the most common finding in CDVT in Alexandria followed by ACA. It is mandatory that the laboratory examination for thrombophilia should be routinely applied to the cases of CDVT not only for diagnostic purposes but also for appropriate treatment