Occult hepatitis B virus infection in Egyptian patients with hepatitis C virus related chronic liver disease

Concurrent infections with hepatitis B virus [HBV] and hepatitis C virus [HCV] are increasingly recognized in patients with both acute and chronic hepatitis and the reciprocal influence of dual infection remains controversial. In Egypt, the last decade showed a remarkable decline in HBV infection associated with remarkable rise in HCV infection. This study investigates the prevalence of occult HBV in adults with HCV related chronic liver disease [CLD] to spot lights on its importance on the clinical outcomes. Ninety five patients with HCV related chronic liver disease [median age 50 yrs] were enrolled in this study. Thirty of them were suffering from hepatocellular carcinoma [HCC]. Sera were tested for HCV antibodies, HCV-RNA [nested RT-PCR], HBV markers [HBsAg, Anti-HBcAb IgM and total, HBeAg] and HBV-DNA [nested PCR for s, c and x regions]. All the studied patients were anti-HCV positive, where 47/95 [49.5%] of them were HCV RNA positive. HBsAg was detected in 25/95 [26.3%] [Overt HBV infection], Total anti-HBc was detected in 52/83 [62.65%], HBV-DNA was positive among 41/95[43.1%] with greatest prevalence for "c" region 39/95 [41%]. HBV DNA positive / HBsAg negative [occult HBV infection] was significantly prevalent in HCV-CLD vs HCC patients[p<0.001], and was found to be significantly increased in those who were HCV RNA positive rather than in HCV RNA negative patients [P< 0.05]. No significant difference was detected between patients with occult or over HBV infection as regard to liver enzymes or Child classification [P>0.05]. Occult HBV infection was found to be significantly increased in HCV related chronic liver disease with [p<0.05]. The high prevalence occult HBV-infection [particularly core DNA] may have clinical implications in the pathogenesis and therapy of HCV induced chronic liver disease. Standardized definition and diagnostic criterion of occult HBV infection are needed for future research to determine its prevalence and clinical significance

Serum levels of soluble CD95 in patients with systemic lupus erythematosus

The present study was carried out on 30 patients with systemic lupus erythematosus [SLE] and ten apparently healthy individuals as a control group.Systemic lupus erythematosus activity index [SLEDAI] was applied to all patients. Anti-double stranded DNA antibodies [Anti-dsDNA Abs.], interleukin-18 [IL-18] and soluble CD95 [Apo-1/Fas] were determined in the sera of all studied subjects. The mean +/-SD SLEDAI in all patients was 15.25+/- 6.76 . The anti-dsDNA antibodies was positive in all studied patients [mean +/- SD 264.36 +/- 114.85 IU/ml]. Serum IL-18 showed significant elevation in SLE patients as compared to the control group [Mean +/-SD 246.13+/- 114.32I U/ml vs. 45.5 +/- 7.32 IU/ml; p < 0.001]. Serum Soluble CD95 [sCD95] showed significant increase in all SLE patients as compared to the control group [Mean+/-SD 648+/-116.96 pg/ml vs. 270+/-50.24 pg/ml; p < 0.001]. Serum sCD95 also showed significant rise in SLE patients with moderate activity as compared to those with mild activity [Mean +/- SD 629.16+/- 72.54 pg/ml vs. 535 +/-35.97 pg/ml; p<0.05]. The serum level of sCD95 in SLE cases with severe activity showed significant increase when compared to those with moderate activity [Mean+/-SD 797.5 +/- 41.66 pg/ml vs. 629.16 +/- 72.54 pg/ml; p <0.001]. Anti-dsDNA antibodies showed significant positive correlation with SLEDAI [r=0.772; p<0.01]. IL-18 also showed a significant positive correlation with the SLEDAI [r=0.670; p<0.01]. Soluble CD95 showed significant positive correlation with SLDAI [r=0.865; p<0.01], with anti-dsDNA antibodies [r=0.775; p<0.01] and with IL-18 [r =0.722; p<0.01]. From these results it was concluded that serum sCD95 is increased in patients with systemic lupus erythematosus and it is correlated with anti-dsDNA antibodies, with IL-18 and with the disease activity, so it can be useful marker of disease activity for proper management and follow up of SLE patients

Stationary manometric survey of non-structural dysphagia

In this study 36 patients complaining of non-structural dysphagia were investigated by stationary oesophageal manometry, of them 29 patients [80.6%] showed primary oesophageal motility disorders. Non-specific oesophageal motility disorders. [NEMD] [41.7%] and achalasia [33.3%] were the most common findings. Diffuse oesophageal spasm DES [2.7%] and hypertensive lower oesophageal sphincter [LES] [2.7%] were less frequent. It was concluded that oesophageal manometry is one of the most sensitive mean of diagnosing early cases of achalasia and further motility study as provocative tests, solid-state system and ambulatory oesophageal manometry are needed for those cases which show normal findings as there may be intermittent disorders