Lupus nephropathy: clinical, immunohistochemistry and quantitative morphometric analysis studies

Lupus nephritis includes a wide range of parenchymal injuries and severity. Better predictors to outcome are needed for patients newly diagnosed with lupus nephritis, so that an appropriate management strategy may be selected. This study aimed to determine whether the ratio of hepatocyte growth factor [HGF] to transforming growth factor beta 1 [TGF beta1] in lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at six months. Also, to determine whether a simple automated system for objective scoring of biopsies of lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at 6 months. Consequently, renal biopsy findings and clinical parameters of thirty parasites-free patients with new onset lupus nephritis were recorded. Histopathologic, clinical, immune-histochemical and morphometric data at baseline served to define the predictive value for outcome after 6 months of therapy. The results showed a significant positive relationship between response to therapy and HGF IS [P= 0.007], HGF ES [P= 0.026], HGF IS/ TGFbeta1 IS ratio [P= 0.022] and HGF ES/ TGFbeta1 ES ratio [P= 0.001]. A significant inverse relationship was proved between response to therapy and TGFbeta1 IS [P= 0.025] as well as TGFbeta1 ES [P= 0.017]. Also, a significant inverse relationship was present between response to therapy and nuclear index, tubular index and matrix index [P = 0.03, 0.03 and 0.029 respectively]

New concept of schistosomiasis lesions of urinary bladder versus development of bladder cancer

Schistosomiasis haematobium precancerous lesions of urinary bladder included group 1: preneo plastic non papillary [flat] lesions [reactive atypia, flat hyperplasia, keratinizing squamous metaplasia, glandular metaplasia, dysplasia, carcinoma in-situ [CIS]] and group 2 preneoplastic papillary lesions [typical papillary hyperplasia, atypical papillary hyperplasia, papilloma]. The present work studied the content of the schistosomiasis precancerous lesions of the urinary bladder using image analyzer, thereby shedding more light on the significance on the early diagnosis of the high risky group. A total of 140 previously diagnosed schistosomiasis urinary bladder lesions [124 precancerous and 16 cancers as controls] were stained by H and E, and Feulgen stain. The mean SPF was high in CIS [22.7], dysplasia [19.6] and low in atypia [7.91]. DNA ploidy, non-diploidy DNA was high in CIS [53%], papilloma, dysplasia and atypical papillary hyperplasia than flat hyperplasia, glandular metaplasia, keratinizing squamous metaplasia and typical papillary hyperplasia that were diploid indicating more tendency and aggressiveness of the first group to turn malignant than the second group

clinical picture of hepatitis C virus as a concomitant infection with fascioliasis

Hepatitis C and human fascioliasis are two of the most important public health problems locally and internationally. Each one has its own complications regarding spreading to man, clinical picture, laboratory and serologic diagnosis, treatment and prevention. Concomitant human infection with both magnified the complications. Clinically, both diseases [HCV and fascioliasis] have their own broad signs and symptoms. In concomitant infection, the clinical pictures of both showed some variations. The most common feature in fascioliasis and HCV patients was easy fatigability in 78.6% and the lowest was 7.18% for each of tympanic abdomen, tender colon, tender right upper quadrant, itching, arthritis, epi-gastric pain, and right quadrant pain. The eosinophilia% ranged from 5-24 and the haemogiobin ranged from 7-11.1 gm/dl. In patients with fascioliasis alone, the most come feature was pallor in 96.15% and the lowest was 3.85% for each of splenomegaly, ascites and itching. Eosinophilia% ranged from 1 to 22 and haemoglobin ranged from 6-12 gm/dl. In general, the double infection with both HCV and fascioliasis magnified the laboratory and clinical pictures of such patients

preliminary pilot survey [culex pipiens], Sharkia governorate, Egypt

Sixteen different ecological areas in Sharkia Governorate were surveyed for adult Culex pipiens. The prevalence was investigated among 160 houses of 2800 individuals and their surrounding outdoors. The collected adults were 41488 from October 2003 to November 2004. The collection rates were higher in the rural areas than urban ones. Mosquitoes were common all the year round except January, February and March, with peaks in summer and autumn than in spring and winter. Larvae in descending order were Cx. pipiens the predominant larva followed by Ae. caspius, Culiseta sp. and then Cx. pusillus. Cx. pipiens was described as the most common larva

liver profile in patients with hepatitis C virus and/or fascioliasis

In this study, twenty HCV/PCR-RNA positive patients with neither infection nor infestation were 15 males and five females with ages ranging between 17-78 years old. Liver function tests: S. albumin was decreased in 15 patients [75%], total protein decreased in 3 patients [15%], total bilirubin increased in 7 patients [35%], AST/ALT increased in 3 patients [15%]. Globulin value increased in 15 patients [75%]. A/G ratio decreased in 12 [60%]. Ten normal individuals [five males and five females], gave normal findings. However, a 19 years-old female had non significant elevation [0.26mg/dl] in direct bilirubin. Liver function tests: one patient had increased AST/ALT, Globulin value decreased [-0.2] in another one [10%] and A/G ratio increased [+0.3 to+0.6] in three [30%] individuals. Twenty randomly selected patients [15 males and five females] HCV/3 rd generation ELISA showed ALT elevation in 17 [85%], AST in all [100%], S. albumin decreased in 9 [45%], and increased in 1 [5%]. Total protein decreased in 3 [15%], total bilirubin increased in 7 [35%] and direct bilirubin in 4 [20%], AST/ALT value increased in 3 patients [15%], Globulin value increased in 15 patients [75%]. A/G ratio decreased in 12 [60%]. Three patients had schistosomiasis, one 30 years old male had increased AST/ALT, normal globulin, increased A/G and positive HBs-Ag. The second one was a 33 years old male had normal AST/ALT, normal globulin, increased A/G and positive HBs-Ag. The third patient was a 19 years old female with normal AST/ALT and normal globulin, increased A/G and positive HBs-Ag. Two patients had fascioliasis, one was a 20 years old male with increased AST/ALT, globulin normal, A/G normal and negative HBs-Ag. The second one was a 26 years old female with normal AST/ALT and normal globulin, increased A/G and positive HBs-Ag. The other four positive HBs-Ag patients were parasite-free. Also, the other HCV/ELISA positive were negative for HBs-Ag. HCV/ELISA may have cross-reacted with HBs-Ag and/or with elevated ALT and gave false positive HCV. The 3rd generation ELISA in detection of HCV was not as sensitive as PCR/RNA. Out of 41 fascioliasis patients [26 males and 15 females], 14 were positive HCV/ELISA [34.1%], but only six were positive HCV/PCR [14.6%]. ALT increased in 18 fascioliasis patients [43.9%], AST in 23 patients [56.1%] but, albumin decreased in 7 patients [17.1%], total protein decreased in 5 [12.2%], but total bilirubin increased in 14 [34.1%] and direct bilirubin increased in 2 [4.9%]. Liver function tests of 14 fascioliasis and ELISA positive HCV showed AST/ALT increased in 6 [42.9%], globulin increased in 3 [21.4%] and decreased in 6 [42.8%]. A/G decreased in 4 [28.6%] and increased in 8 [57.2%]. Liver function tests of pure 27 fascioliasis patients showed that AST/ALT increased in 8 [29.6%], globulin increased in one patient [3.7%] but decreased in 10 [37.0%] and A/G ratio increased in 13 [48.1%]

HCV/PCR positivity in bile and doudenal aspiration of Fascioliasis and/or HCV patients

In this study, three bile aspirates taken from 10 fascioliasis patients [30.0%] showed HCV positivity by PCR/RNA. Also, four duodenal aspirates [66.7%] taken from six HCV/PCR RNA positive patients and three duodenal aspirates [20%] taken from 15 pure fascioliasis patients showed HCV positivity by PCR/RNA This is the first time to demonstrate HCV/PCR-RNA in the bile and duodenal aspirates of fascioliasis patients and in the duodenal aspirates of HCV patients. So, PCR can be used for the detection of HCV in the bile and/or duodenal aspirates of HCV suspected patient. On the hand, this outcome results may incriminate HCV infection as concomitant with fascioliasis or incriminate fascioliasis as paving the way to HCV.

liver function profile in PCR-RNA Egyptian HCV-patients and normal controls

No doubt. Hepatitis C virus [HCV] is a real health problem worldwide. The liver function tests [S.ALT, S.AST, Albumin, Total Protein, Total Bilirubin and Direct Bilirubin] were evaluated in 20 PCR-RNA positive HCV-patients and 10 cross matched apparently healthy population. All the HCV-patients and controls were free from liver helminthes. The results showed that in the HCV-patients, there was elevation in the level of S.ALT [17/20 or 85%], S.AST [20/20 or 100%], Total Bilirubin [7/20 or 35%], and [4/20 or 20%]. Besides, there was neither a correlation between sexes nor the degrees of viraemia and the elevation of these four parameters. However, serum levels of Albumin, and Total Protein were within the normal range. On the other hand, in the controls the levels of the six tests were within the normal range. Nevertheless, only one control subject who had positive HBs-Ag, showed elevated Total Bilirulin and Direct Bilirubin. Consequently, these tests are indicative as useful and dependable markers in the noninvasive diagnosis of the hepatitis C virus [HCV]

Proliferative changes of epidermal cells in lesions of cutaneous leishamaniasis

In 35 parasitologically proven zoonotic cutaneous leishmaniasis patients, the histopathological and immunohistochemical picture were studied. The haematoxylin and eosin stain, the monoclonal antibodies for T and B lymphocytes, peroxidase anti-peroxidase for P53 protein, and Feulgen staining for DNA imaging cytometry to DNA contents and S-phase [DNA synthesis of cycling cells were evaluated. The out-come results revealed that P53 and S-phase fraction and DNA content must be in mind when dealing with a human cutaneous leishmaniasis. Consequently, the early detection of any nuclear mutation and cellular proliferation in the skin leishmaniasis lesion[s] must be taken into consideration to avoid the miserable formation of the skin cancer

Hepatitis C virus infection at Sharkia Governorate, Egypt: Seroprevalence and associated risk factors

A sample of 1422 individuals was included in the study, using multistage sampling technique. Exposures and demographic characteristics were obtained through a pre-designed questionnaire. Antibody to HCV was assessed using micro-particle enzyme immunoassay [MEIA] enzyme assay by IMX and the HCV RNA was tested by real-time PCR technique using ABI Prism 7700 system. The seroprevalence of antibodies to HCV was 23.4% and 27.4% in urban and rural areas, respectively, with an overall prevalence of 25.8%. This reflected prior HCV infection, but not necessarily a current liver disease. The prevalence was higher among males than females and increased sharply with age, from 4.8% in those <20 years old to 41.9% in the older ages [>/40 years]. Those who were not educated and farmers had a significantly high prevalence. The significant predictors of HCV infection were previous parenteral therapy for schistosomiasis [OR = 4.3, 95%, CI = 3.6-7.9], among those over 20 years of age [3.5, 2.18-5.8], blood transfusion [4.1, 2.4-6.9], invasive procedures [surgery and endoscopy] and the use of contaminated syringes and needles. Also, shaving at community barbers added a significance to the model

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

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

Non - histological assessment of liver fibrosis in HCV infection

In this study, a correlation between some serum markers [alanine aminotransferase/ aspartate aminotransferase [AST/ALT] ratio, level of matrix metalloproteinase 9 [MMP9], level of viremia and HCV serotype] and the severity of liver fibrosis in HCV-infected patients was detected. The study included 72 human cases referred to the Early Cancer Detection Unit for liver biopsy assessment. The severity of liver fibrosis was staged, using the METAVIR scoring system, into four stages. The level of viremia did not differ significantly in the different stages of liver fibrosis. Also, the type of HCV had no effect on the severity of liver fibrosis. However, transaminases ratio differed significantly in the different fibrosis stages. This serum test showed relative high sensitivity and specificity [92.6% and 94.38, respectively] in diagnosing severe fibrosis and cirrhosis. However, the level of MMB was inversely correlated with the fibrosis stages and was found to have 88.9% sensitivity and 88.6% specificity when diagnosing severe fibrosis and cirrhosis. Although, the sensitivity of these serum markers did not reach 100%, yet their use can reduce the number of liver biopsies when diagnosing and treating HCV-infected patients

DNA ploidy and S - phase fraction in the patients of chronic HCV and hepatocellular carcinomas

In this study, 400 blue Feulgen-stained nuclei were measured from each lesion using DNA image cytometry. The histopathological and cytopathological observations revealed that 52 cases had variable degrees of chronic hepatitis, 12 cases were emerging into cirrhosis; while 11 cases represented different grades of HCC. Most of cases with minimal or mild chronic hepatitis were females, while most of the males had moderate or severe chronic hepatitis, cirrhosis and HCC. DNA image analysis data helped in the histological observations. All of chronic hepatitis C and cirrhotic cases showed normal diploid and/or tetraploid histograms; while they showed increasing S-phase fractions' values of the highly diseased chronic hepatitis and cirrhotic cases. Hepatocellular carcinomas and one cirrhotic case only revealed aneuploidy [diploid and tetraploid], while one case of poorly differentiated HCC revealed multi-ploid histogram

Experimental demonstration of hepatitis C virus [HCV] in an Egyptian strain of Culex pipiens complex

Reverse transcriptase [RT] polymerase chain reaction [PCR] was used to detect hepatitis C virus [HCV] RNA among heads, guts, larvae and eggs of Culex pipiens complex. The mosquitos were trapped from homes of hepatitis C patients or among the same organs of symbiotic [normal gut bacteria] and aposymbiotic [without gut bacteria] mosquitos fed HCV positive blood by an artificial membrane feeder. The eggs and larvae resulted from symbiotic females fed HCV positive blood were tested for HCV-RNA. Hepatitis C virus RNA was detected only in the heads of symbiotic mosquitos collected from homes of HCV positive patients at 3 and 6 hours after feeding. The virus was detected at 3 and 8 days after being fed on HCV-RNA positive blood in guts of the same group. The virus was not detected in the eggs or larvae resulted from female mosquitos fed on HCV-RNA positive blood

Study of percentage of population in s-phase in primary meningioma by dna flow cytometry as predictor for recurrence: correlation with clincopathologic prognostic factors

Despite the gross total resection of meningiomas, there is a significant rate of recurrence approaching 20% at 20 years. The prediction of recurrence by clinical and histopathological factors are inadequate, Flow cytometric analysis of deoxyribonucleic acid [DNA] in meningiomas has shown a correlation between a high proliferative index based on tumor cell- cycle stage [percentage of S and percentage of G2/M] and clinically aggressive behavior. Accordingly the DNA analysis of meningioma may be of value in predicting recurrence of the tumors. A series of 130 meningiomas with gross total resection were analyzed. All available microscopic slides were reclassified according to the revised World Health Organization system [WHO].Sections were then taken for flow cytometry study. Thirty-eight [29%] of primary meningiomas associated with recurrence. Only strong significant correlation of histological grading, mitotic index and tumor necrosis with recurrence [the recurrence indices were respectively 27% in Gl meningioma, 75% in GII and 100% in GIII meningiomas [p < 0.001]. Mitotic counts were statistically higher in the recurrent group [6.32 +/- 5.44 for recurrent meningioma and 0.51 +/- 0.53 for non-recurrent. The difference between the two groups was statistically significant [p< 0.001], and necrosis was more observed in recurrent meningioma in 15 cases of 27 cases had tumor necrosis. DNA flow cytometry analysis showed that recurrent benign meningiomas had high SPF in comparison with that benign without recurrence. [SPF mean 10.86 +/- 5.5 and 7.35 +/- 2.8 respectively]. In conclusion these results support the suggestion of that flow cytometry may be of value in the prediction of recurrence of histologically benign macsroscopically removed meningiomas

histopathological picture of the liver hamsters experimentally infected with leishmania d. infantum on top of schistosoma mansoni infection

The histopathological picture of the liver of Syrian golden hamsters experimentally infected with Leishmania d. infantum on top of pre- infection with S. mansoni was studied. The results showed that the liver was markedly affected by the concomitant infection than infection with either parasite alone. The superadded Leishmania infection caused the early appearance of cell necrosis and fatty changes. The schistosomal granulomas were rounded in shape and well circumscribed. However, they were smaller in size and less in number when compared with schistosomal control. Also, there was a comparative decrease in the number of their cellular constitutions, but without a change in the cell types. The schistosomal granulomas were surrounded with a rim of amastigotes laden macrophages. On the other hand, the leishmanial granulomas were irregular in shape, but comparatively increased in size and in number on the behalf of the schistosomal granulomas. Their cellular constitutions comparatively increased. So, it was concluded that the L. d. infantum infection on the top of S. mansoni infection suppressed the schistosomal pathological picture in the liver of hamsters

Renal changes in golden hamsters experimentally infected with leishmania d. infantum on top of schistosoma mansoni infection

This work aimed to study the concomitant infection of L. d. infantum on top of S. mansoni infection in Syrian golden hamsters, the model animal for both parasites. The results showed that the renal changes were more or less the same as infection with either parasite alone. Both parasites produce mesangial cell proliferation and mesangial matrix increase. Some glomeruli showed complete replacement of the capillary tuft with structureless homogenous material. In one S. mansoni positive control hamster, Schistosoma eggs were seen within granulomas and atrophic glomeruli. However, the leishmanial infection, more or less suppressed the schistosomal infection. The leishmanial infection itself became more prominent and the renal lesion appeared earlier and was more obvious