Factors associated with increased insulin resistance in non-diabetic patients with chronic hepatitis C

Our aims were to investigate the factors associated with increased insulin resistance in non-diabetic chronic hepatitis C patients. HCV-infected patients without DM [n= 28] which was further subdivided into non-cirrhotics and cirrhotics were compared with age-and sex-matched patients with chronic hepatitis C with type 2 DM [n = 22], also, it was subdivided according to the presence or absence of cirrhosis, and healthy controls [n =6]. Serum insulin level, serum ferritin and blood glycated haemoglobin levels were calculated using ECLIA [electro-chemiluminescence immunoassay], ELISA and Quantitative Colorimetric method respectively. Homeostasis model assessment insulin resistance index [HOMA-IR] and B cell function [HOMA-B] were calculated. There was significant difference regarding age between CHC [chronic hepatitis C] cirrhotic diabetic group and control and non-diabetic non-cirrhotic group [P=0.001]. Age is correlated with IR [p=0.006], HOMA-IR [p=0.004] and HOMA-B [p=0.041]. BMI [Body mass index] is correlated with IR [p=0.02], HOMA-IR [p=0.046] and HOMA-B [p=0.02]. Albumin is correlated with IR [P<0.001], HOMA-IR [0.001] and HOMA-B [P<0.001]. SCOT is correlated with IR [p=0.006], HOMA-IR [p=0.018] and HOMA-B [p=0.005]. SGPT is correlated with IR [p=0.003], HOMA-IR [p=0.007] and HOMA-B [p=0.011]. Platelet count is negatively correlated with IR [P<0.001], HOMA-IR [P<0.001] and HOMA-B [P<0.001]. findings indicate that older age, obesity and high serum ferritin level help identify those HCV patients who have potential risk factors for development of DM and increased level of Insulin resistance and control of these factors like obesity or serum ferritin level may help to improve insulin sensitivity in these patients

Percutaneous ablation [radiofrequency and ethanol injection] versus hepatic resection in treatment of HCC in Egypt

Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed

Relation between T lymphocytes activities and the intensity of schistosoma mansoni infection

This study was done on 60 schistosome patients and 12 cross matched healthy control persons. The schistosome patients were classified on the bases of intensity of infection into: 22 patients with light infection [one to 100 eggs/gm stool], 24 patients with moderate infection [101- 400 eggs/gm stool], 14 patients with heavy infection [>400 eggs/gm stool]. All the studied cases were submitted to flow cytometric analysis of peripheral blood mononuclear cells using monoclonal antibodies against CD3, CD4, CD8, CD28, HLA-DR. It was found that there was a significant decrease in CD3, CD4 and the expression of costimulatory molecule CD28 on CD8 T lymphocytes, while CD8 T lymphocytes and the activation marker HLA-DR expression on CD4 T lymphocytes were increased. These changes were more obvious with the increase in intensity of infection

Serum leptin level in chronic hepatitis

This study was planned to evaluate serum leptin levels in patients with chronic viral hepatitis or liver cirrhosis. The study included 80 patients with chronic viral hepatitis [chronic hepatitis C positive group [41 patients]. 23 non-cirrhotic and 18 patients post HCV cirrhosis. Chronic hepatitis B patient [25 patients] 10 patients non-cirrhotic and 15 post HBV cirrhosis. Chronic hepatitis B and C virus positive group. [14 patients] 6 non-cirrhotic and 8 patients post HBV and HCV cirrhosis. 10 healthy subjects of matched age and sex as a control group. The study showed that serum leptin levels was significantly elevated with non-cirrhotic and cirrhotic cases [chronic hepatitis] than the control while the highest concentration being seen in cirrhotic patients. There was a non significant difference in serum leptin levels with the different etiology of non-cirrhotic chronic viral hepatitis. Serum leptin levels showed a non significant difference between different Child classes. Serum leptin levels are sex dependent, higher in females than males. Serum leptin levels correlated positively with [BMI], this correlation was significant in females while not significant in males. Serum leptin was correlated positively with serum bilirubin, on the other hand serum leptin levels was inversely correlated significantly with serum albumin but no correlation with SGPT or SGOT. It can be concluded that in the course of chronic viral liver disease, serum leptin levels may reflect the extent of liver dysfunction Serum leptin levels is higher in patients with chronic hepatitis and is significantly increased in cirrhotic than non-cirrhotic and there is no correlation between BMI and its level

histo-pathology of human Giardiasis

This study was carried out on a sample of 1240 adult persons. In giardiasis symptomatic group [I], the prevalence of diarrhea was 71.43%, 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically insignificant in comparison with each other. The prevalence of abdominal pain was 71.43%, 73.33%, 95%, 91.67% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically insignificant compared with each other. The prevalence of flatulence was 42.86%, 40%, 80%, 83. 33% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically significant in comparison with each other. So, the prevalence of flatulence was more frequent in patients with marked pathological changes in the duodenum. The prevalence of anorexia was 14.29%, 53.33%, 65%, 50% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically significant in comparison with each other. The prevalence of vomiting was 0%, 13.33%, 15%, 16.67% and 85.71% in grade 0, I, II, III and IV pathology, respectively, which was significantly increased in grade IV and disappeared in grade 0

Coccidiosis among malnourished children in Mansoura, Dakahlia, governorate, Egypt

Stool samples of 36 malnouished and 36 healthy control children were examined for oocysts of Cryptosporidium parvum, Cyclospora cayetanensis Isospora belli, and Microsporidium. C. parvum infection [single and mixed] was detected in 13.9% and 5.6% in malnourished and control children respectively. C. cayetanensis oocysts were detected in 5.6% malnourished children and in 2.8% of control group. I. belli oocysts were detected only in malnourished children 2.8%. On the other hand, no Microsporidium oocysts were detected in both malnourished and control children

Immunogenetic study of diabetic patients with periodontal disease

This study compared the periodontal status of diabetic patients [whether insulin-dependent or non-insulin-dependent] with non-diabetic patients, in addition to the determination of the level of IL-8, and the frequency of HLA class I and class II antigens on lymphocytes among these patients and comparing them with the control group. The study groups consisted of 28 male patients with an age from 30 to 60 years and 10 healthy control subjects of similar age and sex. Clinical periodontal evaluation were performed for all teeth in each patient using Russel periodontal index. Blood was obtained from all subjects for the determination of the level of protein concentration of IL-8 using ELISA technique. Class I and class II HLA antigens were determined by the microlymphocytotoxicity assay. Analysis of the data demonstrated no statistically significant difference in the overall means for all diseased groups as regards the periodontal index [PI]. However, insulin-dependent diabetic patients [IDDP] showed highest mean, while non-diabetic patients had the lowest mean [P >/0.05]. The mean blood levels of IL-8 in all the diseased groups were significantly higher than the mean blood level of IL-8 in the control group, i.e. the difference among the four groups were highly significant [P <0.001]. There were no significant difference between the distribution of HLA antigens between the diseased groups and the control group in any class except in HLA [B37 + W67] which was significantly higher in NIDD than the control group [P <0.05]

Importance of E hislolytica antigen in serodiagnosis and follow-up of patients with amoebic liver abscess

This study was composed of two sections: A community based study and a hospital based study. The community based study was conducted on 200 apparently healthy individuals who were chosen randomly from rural areas. They were examined clinically, sonographically and their stools were analyzed microscopically for E. histolytica cysts. They were examined serologically by ELISA test for the circulating amoebic antigen to determine the normal titer of antigenemia among healthy individuals and cyst passers. It was found that all of them were negative for antigenemia at 1/16 which was considered the diagnostic titer of amoebic hepatitis. The study was carried on 27 patients suffering from amoebic liver abscess [ALA] to detect the role of circulating amoebic antigen in the diagnosis and follow up of these cases. Circulating amoebic antigen was detected in 66.66% of patients with ALA before therapy which was decreased significantly to 14.82% two months after therapy. There was no significant association between the diameter of the abscess and the titer of the circulating amoebic antigen in their sera

Toxoplasma lgG and lgM antibodies, a case control study

This study includes 62 eases of spontaneous abortions and 75 cross matched non pregnant multiparous women as controls. Micro - ELISA test was done to assess the extent of infection by Toxoplasma IgM and IgM antibodies. Out of 62 aborting women, 26 gave positive antitoxoplasma IgG antibodies [43, 56%] more than 45 Eu/ml and 28 gave positive antitoxoplasma IgM antibodies more than 40 Eu/ml without statistical significant difference. There was a significant difference between aborting women and the controls as regards IgG and IgM antibodies. Regarding antitoxoplasma IgG antibodies, there was a statistical significant difference between those with no previous abortions or 1 - 2 abortions versus those with 3 and more abortions. The infection was more among aborting women in rural than urban area. Also it is evident than risk factors contributing to the tranmission of disease among aborting women indicate unhygienic measures awareness about the mode of transmission of toxoplasma infection. It is recommended that women should be protected from toxoplasma infection and routinely examined for toxoplasma antibodies before marriage or pregnancy

Importance of E histolytica antigen in serodiagnosis and follow-up of patients with amoebic liver abscess

A community - based study was conducted on 200 apparently healthy individuals randomly chosen from rural areas. They were examined clinically, sonographically and parasitologically for E. histolytica cysts and by ELISA for circulating amebic antigen. They were negative for antigenemia at 1/16, which was considered the diagnostic titer of amebic hepatitis. A hospital - based study was carried out on 27 patients suffering from amebic liver abscess [ALA]. Circulating amebic antigen was detected in 66.66% of them before treatment, which decreased to 14.82% 2 months after treatment. There was no significant association between the diameter of the abscess and the level of circulating amebic antigen. It was concluded that the circulating amebic antigen may be useful for the diagnosis and follow up of amebic liver abscess patients