Procoagulant versus anticoagulant factors in cirrhotic patients

Liver cirrhosis leads to decreased production of clotting factors that are generally all produced in the liver except factor VIII and von Willebrand factor. However, cirrhotic patients are not protected from thrombosis. The present study aimed to assess the procoagulant and anticoagulant factors in cirrhotic patients with and without bleeding and/or thrombotic events. A total of 102 adult subjects were enroled: 51 cirrhotic patients and 51 healthy controls. After full history taking with special attention given to thromboembolic and haemorrhagic events, platelet count, serum albumin, bilirubin, international normalised ratio [INR], PT, partial thromboplastin time [PTT], hepatitis B surface antigen [HBsAg], hepatitis B core [HBc] antibodies, hepatitis C virus [HCV] antibodies, factor VIII, protein C, Protac-induced coagulation inhibition percentage [PICI%] assay and abdominal ultrasound were performed for patients and controls. Upper gastrointestinal endoscopy was conducted for the patients. Compared with control subjects, factor VIII and factor VIII/protein C were significantly higher, while protein C and PICI% were significantly lower among patients. Patients with liver cirrhosis may have a tendency for bleeding or thrombosis according to the balance of coagulant and anticoagulant status. PICI%, the assay that evaluated the functionality of the protein C anticoagulant system, was significantly lower in patients compared to control subjects. Accordingly, low PICI% and high factor VIII/protein C ratio can be taken as an index of hypercoagulability in cirrhotic patients

Detection and differentiation of entamoeba histolytica and entamoeba dispar isolates in clinical samples by PCR

A total of 140 out of 180 outpatients attended MISR University for Science and Technology Hospital complained of abdominal pain, diarrhoea and/or dysentery. Stool examination showed 47 [33.6%] had Entamoeba sp., 36 [25.7%] had cysts and 11 [7.9%] had trophozoites. Of 40 asymptomatic ones, 4 [10%] had cysts. A total of 51 positive stool samples for Entamoeba sp. [40 cysts and 11 trophozoites] were tested by Ne-sted Polymerase Chain Reaction [N-PCR] and Restriction Enzyme Digestion [RED] to clarify true E. histolytica from E. dispar. The results showed that 9/51 [17.6%] had E. dispar, while 31 [60.8%] had E. histolytica and 11 [21.6%] had dual infection with both E. histolytica and E. dispar. All E. histolytica PCR proved cases were from the symptomatic group, 11 had trophozoites and 34 had cysts. Thus, the result showed the potential use of molecular tools in detection of E. histolytica and E. dispar, and is a promising tool for epidemiology, particularly to differentiate pathogenic and non pathogenic Entamoeba sp

Co-infection with cryptosporidium parvum and cyclospora cayetanensis in ummunocompromised patients

Forty nine stool specimens collected from severe diarrheic patients. Eight were suffering from Hodgkin's lymphoma, and the rest were suffering from acute lymph plastic leukaemia. All were examined microscopically for protozoan parasites mainly, Cryptosporidium parvum and Cyclospora cayetanensis. Of the patients, 34 [69.4%] were positive and 15 [30.6%] were negative by both microscopy and nested PCR. An additional 12 [24.5%] who were negative by microscopy were positive by nested PCR. Stool examination revealed 16 cases with C. parvum, and 6 with C. cayetanensis, and 3 cases showed mixed infection. The results were compared with the established nested PCR assay to detect DNA directly from stool specimens. The patients <3 years old more affected by Cryptosporidium infection, unlike Cyclospora sp. Infection was in older age groups, which reflected the modes of parasite' transmission. Diarrheal illness was stronger for Cyclospora than for Cryptosporidium. After the extraction of DNA from stool, a 402-bp fragment of C. parvum, and 602 bp fragment of C. cayetanensis was amplified. The amplified products, 194-bp DNA fragment for C. parvum, and 306 bp DNA fragment of C. cayetanensis were used for the second run. This study indicated that primers were specific for DNA of C. parvum and C. cayetanensis. PCR detected a total of 22 [44.9%] positives for C. parvtim infection [6 negative by AF stool examination], and 12[24.5%] positives for C. cayetanensis. Infection [6 negative by AF stool examination], 7[14.3%] showed mixed infection [4 negative by AF stool examination], all microscopic negative specimens were positive by successive stool examination. Microscopy exhibited sensitivity of 72.7% for C. parvwn, 50% for C. cayetanensis and 100% specificity for both parasites compared to 100% sensitivity and specificity with PCR. So, PCR is more sensitive and easier to interpret but required more hands-on time to perform and is more expensive. However, PCR batch analysis reduces the cost considerably