Evaluation of the diagnostic value of serum and tissue apoptotoic cytokeratin- 18 in patients with chronic hepatitis C

Hepatitis C virus [HCV] is considered the most common aetiology of chronic liver disease [CLD] in Egypt. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma. A role for apoptosis in liver damage caused by HCV chronic infection has been suggested. Cytokeratin 18 [CK-18] is the major intermediate filament protein in the liver and is a known caspase substrate in hepatocyte apoptosis. Therefore, we analysed the serum and tissue levels of CK-18 in patients with chronic HCV infection to evaluate its role in hepatocyte apoptosis. We also correlated CK-18 expression with the severity of hepatic pathology. This study examined 80 Egyptian patients with liver disease. There were 69 patients with chronic hepatitis C and 11 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. The levels of CK-18 fragment were quantified in paired serum and liver biopsy samples. The serum and tissue CK-18 levels were reduced in chronic HCV patients compared to early cirrhosis patients. This result indicates that serum levels of CK-18 and the hepatic expression of CK-18 might play an important role in disease progression. The serum and tissue levels of CK-18 were significantly increased and directly correlated with inflammation severity, stage of fibrosis, and ALT levels in the chronic HCV group and the cirrhotic liver group. There was no significant difference in viral load between patient cohorts. The serum level and the hepatic expression of CK-18 are related to disease activity and are directly correlated with METAVIR scoring. This result suggests that serum CK-18 levels may be useful for monitoring disease activity in chronic HCV and liver cirrhosis patients

Risks for bacteremia and urinary tract infections in febrile young children with respiratory syncytial virus-bronchiolitis

This study was done to evaluate the risks of bacteremia and urinary tact infections [UTI] in febrile patients with respiratory syncytial virus [RSV] -bronchiolitis. One hundred infants and children were selected from emergency department [ED] and outpatient clinic of El-Minia University and El-Galaa Teaching Hospital. They were divided into three groups: bronchiolitis group [40 patients], group of febrile children without obvious cause for fever [30 patients], and control group of normal healthy non febrile children [30 infants and children]. Apart from thorough physical examination, they were investigated for respiratory syncytial virus [RSV] detection in nasal aspirate, bacterial infections by WBCs count, absolute neutrophil count [ANC] and absolute band count [ABC], bacteremia by blood culture, and UTI by urine culture and bacterial count. We found a significant difference on comparison, for temperature, WBCs count, ANC, and ABC, between group with bronchiolitis only and control group on one hand and between febrile group without bronchiolitis and control group on the other hand [p <0.0001]. While on comparison between group with bronchiolitis only and febrile group without bronchiolitis, the difference between them for the same risk factors was not statistically significant [p >0.05]. Also, patients in group with bronchiolitis had more abnormal X- ray chest findings than those in the other two groups. On the other hand, more positive cases for blood culture and bacterial cell count were found among patients in febrile group without bronchiolitis [46.6% and 40% respectively] than among those in group with bronchiolitis [32.5% and 20% respectively] and control group [0.00%]. We recorded high risk of bacteremia and UTI in febrile patients of RSV bronchiolitis but less than that of febrile patients without focal infections. Therefore, evaluation of RSV bronchiolitis for bacterial infections including bacteremia and UTI may be necessary especially in developing counties

Serum autoantibodies in biliary atresia

Biliary atresia [BA] is an inflammatory fibrosing process of unknown etiology, affecting both the extrahepatic and intrahepatic biliary tree, resulting in obliteration of the biliary tract. It represents a major cause of cholestasis in infants, its most common surgically correctable cause and also the leading indication for orthoptic liver transplantation in children. Several etiological factors have been suggested including congenital, metabolic, infectious, vascular malformations and multifactorial lesions. However, no agent has been conclusively implicated in its pathogenesis. The present study aimed at evaluating the potential role of autoimmunity in the etiology of biliary atresia through assessing autoimmune antibodies serum levels in affected infants. The study was carried out on 27 infants [13 boys and 14 girls] attending the pediatrics hepatology clinic of El-Menia University Hospital. Twenty healthy infants [9 boys and 11 girls] attending the outpatients clinics of the same hospital were also included in the study to serve as a control group. Serum levels of the following antibodies were evaluated in all study participants: anti-nuclear antibodies [ANA], anti-mitochondrial antibody [AMA], anti-smooth muscle antibody [ASMA], antineutrophil cytoplasmic antibody [ANCA] and liver-kidney microsomal antibody [LKMA]. Anti-smooth muscle antibody was the most frequently encountered antibody in our series, detected in 70.3% of cases, followed by ANA in 59.2%. The remaining antibodies, on the other hand, were infrequently detected. AMA and ANCA were detected each in 2 cases [7.4%] and lastly LKMA in a single case [3.7%]. These findings suggest that autoimmunity may be involved in the pathogenesis of bile ducts injury and obstruction in BA at least in some cases and support the heterogeneous nature of the illness

Impact of renal functional impairment on serum tumor markers levels

The objective of this work was to study the impact of renal functional impairment on the circulating levels of alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], and cancer antigen 19-9 [CA-19-9]. Fifty-one subjects were enrolled in this study. They were divided into three groups. The first group consisted of 13 apparently healthy volunteers [five males and eight females] as a control group. The second group included 17 patients with end stage renal failure [ESRF] [eight males and nine females]. The third group comprised 21 patients [12 males and nine females] with ESRF maintained on hemodialysis [HD]. Tumor marker determinations were performed using enzyme-linked immunosorbent assay. Data management and analysis were performed using Statistical Analysis Systems. Data were summarized using means and standard deviations. Comparisons between groups were done using Kruskall-Wallis, nonparametric analysis of variance. To measure the strength of the association between two numeric variables, Pearson's correlation coefficient was computed. All p-values are two-sided. P-values <0.05 were considered significant. The results suggested that renal functional impairment should be added to the list of benign conditions associated with high serum CEA and CA-l9-9 levels. Before interpreting a tumor marker result in a patient with compromised renal function, it was showed that renal impairment might induce a misleading tumor marker elevation. The lack of significant correlation between elevated serum tumor marker values and serum creatinine and/or urea, and the observed normal serum AFP values raises many questions about the exact mechanisms responsible for increased some tumor markers levels in uremia. The recorded conflicting results of serum tumor markers in uremia indicated that the study of tumor marker kinetics in uremic patients deserves a more considerable attention

Study of the interaction between insulin, insulin-like growth factor-1 [IGF-1] and sympathetic nervous system in patients with hepatorenal syndrome

The current study was conducted to understand the interactions between the sympathetic nervous system [SNS], insulin and IGF-1 in cirrhotic patients with renal impairment. This study included 42 patients with cirrhosis [14 cases without ascites, 16 with ascites and 12 with HRS] and 13 healthy subjects as a control group. Enzyme immunoassay technique was used for measurement of serum insulin, serum IGF-1 plasma noradrenaline and plasma neuropeptide Y [NPY]. The results suggested that low circulating IGF-1 might contribute to renal functional impairment in cirrhotic patients. Further studies are necessary to evaluate whether IGF-1 can become a useful therapeutic agent in patients with liver cirrhosis and HRS. Progressive impairment in systemic hemodynamics in cirrhotic patients might underlie a detective sympathetic response which deserves intensive research studies

Effect of different dialysis membranes on endogenous antioxidant enzyme activity and lipid peroxidation in haemodialysis patients

This work aimed to clarify the most suitable type of the haemodialysis membranes in order to minimize the disequilibrium between the levels of oxidant and antioxidant factors in haemodialysis patients. This study was conducted on 79 subjects who were classified into 5 groups: The 1st group included 14 apparently healthy volunteers, the 2nd group included 13 patients with end stage renal disease [ESRD] just before the beginning of haemodialysis treatment [predialysis], the 3rd group included 18 patients with ESRD on maintenance haemodialysis using dialyzers equipped with cuprophane membrane, the 4th group included 14 patients using polysulphone membrane and the 5th group included 20 patients using hemophane membrane. All participants were subjected to thorough clinical examination and laboratory investigations [estimation of superoxide dismutase [SOD], glutathione peroxidase [GPx], catalase and lipids peroxides [MDA + 4-HNE], serum urea, creatinine, uric acid, fasting and postprandial blood sugar, haemoglobin, haematocrit, creatinine clearance and protein 24 hours urine]. The results revealed that serum lipid peroxides [MDA and 4-HNE] were significantly increased in all patients groups compared to the control group and more significantly elevated in the 3 dialyzed groups compared to the predialysis and alsosignificantly higher in the cuprophane group when compared to the other 2 membranes [polysulphone and haemophane]; while no significant change was detected between the haemophane and the polysulphone groups. There were significantly decreased levels of endogenous antioxidant enzymes [SOD, GPx and plasma catalase] in all patients when compared to the control group. SOD and catalase were significantly lower in the dialyzing groups when compared to the predialysis one; while GPx showed significant decrease only on using cuprophane membrane but not with polysulphone and haemophane. Significant negative correlation between serum lipid peroxides and each of the three antioxidant enzymes was found. Positive correlation existed between haemoglobin concentration, haematocrit and antioxidant enzyme activities. This study confirmed the presence of disequilibrium between the oxidative stress and the antioxidant protective enzymes in uraemic patients; this permanent oxidative stress could act as important mediator to the progression of renal failure and to associated complications such as anaemia and atherosclerosis. This disequilibrium is maximally enhanced by the use of incompatible membranes [cuprophane], while it is significantly reduced on using biocompatible ones [polysulphone and haemophane]. Consequently, in view of the results, the universal use of biocompatible membranes for haemodialysis in a trial to decrease the hazardous effects of haemodialysis is recommended

overview of the histochemistry of the retinal matrix

The constituents of the retinal matrix may be involved in the transport of nutrients from the choroidal circulation to the retina, its molecules may provide trophic support to retinal pigmented epithelium. Relatively little is known about the molecular structure of the retinal matrix. The aim of this work was to clarify the histochemical nature of the constituents of the matrix of the different layers of two types of retinae; vascular and avascular. The retinae were obtained from two groups of animals, retinae of cats and rats [vascular retinae] and retinae of rabbits and Guinea pigs [avascular retinae]. The prepared retinal sections were subjected to these techniques: Hx and E, alcian blue, PAS, silver impregnation, and to modified Landers technique [1991][10]. Quantitative morphometric study was applied through the use of the image analyzer computer system. The obtained results revealed that Muller cells were clearly demonstrated in all examined retinae, their presence was discussed from the fact that they are similar to neuroglia of CNS. They provide structural support to all layers of the retina. They also mediate the transfer of essential metabolites to the retinal neurones. Acid mucopolysaccharides were clearly demonstrated in the matrix of rods and cones, inner nuclear layer and around the neurones of the ganglion cell layer of the vascular retinae more than in the avascular retinae. Neutral mucopolysaccharides were highly demonstrated in the matrix of the rods and cones, plexiform layer as well as in the ganglion cell layer of both vascular and avascular retinae. Chondroitin sulphate proteoglycans were clearly demonstrated in the superficial and deep parts of the matrix of rods and cones, plexiform layer and around the neurones of ganglion cell layer. The obtained results were discussed in relation to the role of the molecular components of this matrix in trophic support of the retinal layers. The matrix fills the small amounts of spaces between the retinal pigmented epithelium and the photoreceptors. The molecular components of the matrix may exert a survival influence upon the normal adhesion between the photoreceptors and the pigmented retinal epithelium. Pathological changes in the molecular components of retinal matrix may be one of the factors which may lead to retinal detachment