Role of hepatitis viruses in egyptian patients with chronic unexplained elevation of serum transaminases

In some patients with persistent alteration of liver enzymes, the cause of [the disturbance cannot be established on the bases of clinical and analytical data. The significance and prevalence of occult viral infections in cryptogenic liver disease remains controversial. The aim of this study was to clarify our lack of knowledge about the exact pathogenic role of known hepatitis viruses in Egyptian patients with chronic unexplained elevation of serum transaminases. Seventy six patients with liver disease of unknown cause were enrolled in this study. In these patients the exact aetiology could not be defined from clinical, biochemical, and serological data. For every patient and before performing the liver biopsy, hepatitis B virus [HBV]-DNA, HCV-RNA and HGV-RNA were assayed in serum by polymerase chain reaction [PCR]. Liver biopsies from these patients showed non specific changes in 23.7%, fatty liver changes in 15.8%, chronic hepatitis in 48.7% and mixed cirrhosis in 11.8%. HBV-DNA and HCV-RNA were detected in serum of 11.8% and 32.9% of patients with cryptogenic disease respectively. Only one patient [1.3%] showed positivity for both viral genomes. Also, only one patient [1.3%] was found to be positive for HGV-RNA. Viraemia was found in 38.9% of patients with pathological non-specific changes, in 33.3% of those with fatty liver, in 51.4% of those with chronic hepatitis, and in 66.7% of subjects with mixed cirrhosis. The results of this study highlight the dominance of chronic viral hepatitis over other forms of liver disease in our country. Also, the routine use of PCR test will pick up most of missed cases of viral infection

EParasite density and morbidity in relation to serum levels of thrombomodulin and E-selectin in the acute phase of plasmodium vivax malaria

Standardized questionnaires, clinical examination and parasitological diagnosis were performed on 40 patients in the acute phase of vivax malaria from the out patient clinics, El Abbassia Fevers Hospital. Serum levels of Thrombomadulin [TM], E-selectin and creatinine were determined in inrolled patients and also in 20 healthy controls. The results, based on multivariable analysis, showed that the clinical diagnosis of malaria including history of fever, rigors, headache, myalgia and palpable spleen was strongly associated with the presence and density of P. vivax malaria even in patients with parasite densities less than l000/micro l of blood and significantly increased the odds of the clinical diagnosis. Results revealed also that the patient's mean +/- SD serum levels of TM and E-selectin were 12.8 +/- 3.67 and 125 +/- 61.4 [u/micro l] respectively, significantly greater than in the controls [TM, P<0.001, E-selectin, P<0.001]. However, no significant differences were identified between patients and controls for serum creatinine values. On the other hand, there was a high significant correlation between levels of parasitemia and serum levels of TM and E-selectin