Hepatitis C virus in peripheral mononuclear cells in patients on regular hemodialysis

Background: Occult hepatitis C virus infection [OCI] was identified as Hepatitis C virus [HCV], characterized by undetectable HCV antibodies and HCV RNA in serum, while HCV RNA is detectable in liver and peripheral blood mononuclear cells [PBMCs] only. Nosocomial transmission in dialysis units maintains a higher prevalence of hepatitis C virus [HCV] infection in patients on maintenance dialysis than in the general population. HCV infection has a detrimental effect on survival in patients on maintenance dialysis and after renal transplantation. The excess risk for death in HCV-positive patients was partially attributed to chronic liver disease with its attendant complications, particularly hepatocellular carcinoma and liver cirrhosis

The aim of this study: was to evaluate the hidden infection of hepatitis C virus among regular hemodialysis patients in Bab Al Sharia University Hospital with negative ELISA and PCR by using PCR in mononuclear cells as a marker in the serum of these patients

Patients and methods:in this prospective study, 60 patients with end-stage renal disease on regular hemodialysis [for at least 6 months duration] were included. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg,. HCV PCR done for all patients in serum and mononuclear cells.. Patients with acute or chronic HCV infection as marked by positive hepatitis C antibody,acute or chronic HBV infections marked by hepatitis B surface antigen,other causes of liver dysfunction [e.g., primary biliary cirrhosis, autoimmune hepatitis, HIV infection] and patient on anti HCV treatment.were excluded

Results: showed detection of HCV-PCR in PBMCs in the absence of HCV-PCR in plasma; was found in three of the 60 patients [3.3%]. All patients had negative HIV, HBsAg, HCV Ab and serum HCV PCR

Conclusion: it could be concluded that testing for HCV-RNA in PBMCs is more reliable than hepatitis serological markers in identifying patients with an OCI when a liver biopsy is not available

Effects of high flux versus low flux on serum c-reactive protein a as an inflammatory biomarker in hemodialysis patients

Background: Traditional low-flux dialysis cannot improve micro-inflammatory status, while new high-flux dialysis can improve the micro-inflammation and lipid metabolism, it helps to improve the quality of life and survival rate of patients, so how to improve the micro-inflammatory status are a focus for researchers

Objective: was to observe the effect of high flux hemodialysis [HFHD] with Gambro polyflux 170H dialyser and low flux hemodialysis [LFPD] with polyflux 17L dialyser on high-sensitivity C-reactive protein in patients with maintenance hemodialysis

Methods: 60 patients with maintenance hemodialysis were randomly divided into HFHD group and LFHD group. Another 20 cases for physical examinations served as normal control group. The maintenance hemodialysis patients were treated with HFHD using 170H dialyser dliahyser and LFHD using 17L dialyser, three times per week, 4 hours once. After 6 months of the treatment, high-sensitive C-reactive protein was determined in patients as well as normal controls before and after treatment

Results and Conclusion: in two groups, the levels of high-sensitive C-reactive protein before the treatment were higher than normal control [P< 0.001]

In HFHD group, serum high-sensitive C-reactive protein markedly decreased [P <0.01]. In LFHD group, these indices remained unchanged after the dialysis for 6 months. HFHD with 170H polysulfone dialyser is effective in improving micro-inflammation in maintained hemodialysis patients

Role of specific clone of lymphocytes, [CD4[+] and CD8[+]] and the sympathetic activity in pathophysiology of altered immunity in ischemic stroke

Ischemic stroke is one of the major causes of high morbidity and mortality allover the world. The understanding of the pathophysiology of post-ischemic immune response is very limited. Cerebral ischemic stroke affects the normally well-balanced interplay of the 2 super systems: the nervous and the immune system. T-cell lymphocytes, [CD4[-], CD8[-]], may contribute to altered immunity associated with stroke. Increased sympathetic activity during ischemic stroke may have a role in altered lymphocytes function. The present study investigated the contribution of CD4[-] and CD8[-] and the sympathetic activity in altered immunity in ischemic stroke. Determination of CD4[-] and CD8[-] percentage in patient's blood was done by flowcytometry. Evaluation of sympathetic activity done by measuring urinary vanilmandelic acid [VMA] levels by spectrophotometry. The study also correlated the changes of these parameters with specific clinical and diagnostic variables in stroke. The study showed that CD4[-] and CDS percentage were significantly lower [p<0.001], while CD4[-] /CD8[-] ratio was significantly higher [p<0.001] in patients than controls. There was also significantly increased [p<0.001] mean urinary VMA excretion levels [mg/day] in patients compared to control group. Significantly lower CD4[-]% and CD4[-] /CD8[-] ratio and higher CD8[-]% were found in patients with recurrent stroke or history of transient ischemic attacks, progressive strokes and large size of infarction in comparison to other comparable patients. The study indicated that patients with ischemic strokes may have altered immunity and sympathetic over-activity which may be one of the mechanisms by which modulation of immune response can be induced after stroke. This brain-immune interaction after stroke may have protective, destructive, or regenerative effects in the brain, therefore the development of therapeutic strategies is not straightforward, and must take all these factors into consideration