Impact of treatment with praziquantel supplemented by silymarin on schistosoma mansoni-induced fibrosis in mice

Schistosomiasis caused by S. mansoni continues to be the most common fibrotic disease resulting from inflammation and deposition of scar tissue around parasite eggs trapped in the liver. Because of the hepatic importance and its ability to regenerate, treating liver fibrosis is of vital significance. Silymarin, a flavinoid complex of Silybum marianum from a plant of the family Asteracea, has received much attention as a potential anti-fibrotic and hepatoprotective agent. To investigate the effect of combining silymarin with praziquantel [PZQ] in the treatment of liver fibrosis in mice infected with S. mansoni. The study was carried out on 120 mice; 96 of which were infected with 100 S. mansoni cercariae and the rest served as non infected controls. Mice were classified into 5 groups, 24 each. G1: Normal control; G2: Infected untreated control; G3: Infected and treated with PZQ, started 6 weeks post infection [PI]; G4: Infected and treated with silymarin, started 4 weeks PI and G5: Infected and treated with silymarin, 4 weeks PI followed by PZQ 6 weeks PI Eight mice from each group were sacrificed on the 10[th], 14[th] and 18[th] week PI. Parasitological, histopathological and biochemical parameters that reflect the disease severity and morbidity were studied. Deposition of extra-cellular matrix [ECM] was determined by estimation of trans-4 hydroxy-L-proline [Hyp] in hepatic cells. PZQ alone showed a significantly high reduction in the mean egg count/gm stool, liver and intestines and was associated with significant increase in the percentage of dead eggs all over the period of the experiment. Silymarin administered alone resulted in slight improvement of parasitological parameters. All the treated groups revealed significant decrease in granuloma diameter especially those after 18[th] week PI Groups treated with silymarin or when combined with PZQ revealed the highest decrease in granuloma diameter at all periods of sacrifice. All treated groups revealed a significant decrease in the Hyp hepatic content. However, the groups treated with silymarin alone or combined with PZQ revealed the most significant decrease in Hyp levels at all periods of sacrifice.The best results obtained, with most of the parameters studied, were in the groups of mice treated with silymarin in combination with PZQ. The use of silymarin combined with PZQ did not affect the chemotherapeutic effect of the latter, and can be safely used with PZQ in patients infected with S. mansoni. Co-administration of silymarin with PZQ reduced the granulomatous inflammatory reactions in the acute and chronic stages of infection. It also had the ability to attenuate liver fibrosis induced by S. mansoni infection. Silymarin can be safely used as an adjuvant with PZQ in the treatment of schistosomiasis mansoni

value of magnetic resonance cholangiopancreatography and selective use of endoscopic retrograde cholangiopancreatography in patient management prior to laparoscopic cholecystectomy

Different diagnostic modalities have been used to asses patients with cholelithiasis before laparoscopic cholecystectomy [LC] for the suspicion of choledocholithiasis. The aim of this study is to define predictive guidelines for patient management with selective use of magnetic resonance cholangio-pancreatography [MRCP] and endoscopic retrograde cholangiopancreatography [ERCP] before LC. ERCP is considered the gold standard for diagnosis and clearance of common bile duct [CBD] stones before LC. MRCP has recently developed as a noninvasive imaging modality for the detection of choledocholithiasis. However it needs further evaluation as regards its diagnostic accuracy in patient management before LC. Between October 2001 and December 2004, 128 patients [88 females, 40 males; mean age 48 [range 14-78 years] with cholelithiasis were prospectively evaluated before LC applying predictive guidelines that include patient information obtained from clinical assessment, blood chemistry tests, and abdominal ultrasonography. Patients were put into one of four groups according to the level of suspicion for choledocholithiasis [group 1, high; group 2, moderate; group 3, low; group 4, very low]. Group 1 patients underwent ERCP with or without endoscopic sphincterotomy for clearance of common bile duct stones; group 2 patients were subjected to MRCP; group 3 patients were operated on by LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography. CBD stones were demonstrated in 15 [11.7%] of 128 patients. The incidence of choledocholithiasis in groups 1, 2, 3 and 4 was 83.3% [10/12], 27.3% [3/11], 7.1% [1/14], and 1.1% [1/91]. rescectively [P < 0.001]. ERCP was successfull in diagnosis and therapeutic clearance of CBD stones before LC in 91.7% [11/12] of patients. It showed a sensitivity, a specificity, and an overall accuracy of 92.3%, 100%, and 91.7% respectively. MRCP was utilized in 8.6% [11/128] of patients. It was unable to detect a CBD stone in one patient, with a sensitivity, a specificity, and an overall accuracy of 75%, 100%, and 91% respectively. lntraoperative cholangiography detected a CBD stone in one patient in group 2, and in another patient in group 3 which were extracted using postoperative ERCP. Only one patient in group 4 had a missed CBD stone which was manifested three months after operation and the patient underwent ERCP with stone clearance. It was concluded that initial evaluation using certain predictive guidelines in patients with cholelithiasis can accurately predict the probability of choledocholithiasis with selective use of MRCP which is an accurate non invasive diagnostic method and ERCP for therapeutic clearance of CBD stones before LC. Thereby improving patient care and resource utilization

Histological studies on praziquantel susceptible and insusceptible S. mansoni isolates

To study the biological differences of PZQ susceptible and insusceptible S. mansoni isolates; three S. mansoni isolates were studied in this work. The first one is the susceptible [Mo] isolate obtained from Egyptian villagers cured after a single oral dose PZQ [40 mg/kg]. The other two insusceptible isolates [Mt22, Mt24] were originally obtained from Egyptian villagers not cured alit three curative doses of PZQ,two doses of 40 mg / kg b.w followed by 60 mg/kg b.w This study revealed the lower PZQ efficacy on both insuceptible isolates [Mt22, Mt24] than on susceptible [Mo] isolate. Under the same circumstances the number of worm burden as well as their biological fitness [egg count/gm liver] were higher in both insusceptible isolates than susceptible one. Also, egg hatchability was low in both insusceptible isolates when compared with its absence in the susceptible one

Biliary enteric anastomosis versus endoscopic biliary stenting in treatment of benign biliary strictures

Surgical repair has been the traditional method of treatment for benign biliary strictures giving good long-term results in most cases. Advances in interventional endoscopic techniques have established the important role of endoscopy in management of such conditions.This study compared the effectiveness of endoscopic and surgical managements of benign postoperative biliary strictures.Over the last 6 years, 31 patients were seen with diagnosis of benign biliary strictures. 21 patients had postcholecystectomy strictures and were included in this study Eleven of these patients were managed endoscopically with insertion of biliary stents and ten patients were treated surgically either by hepaticojejunostomy orcholedochojejunostomy. The mean follow up period was 28 + 11.5 months in the endoscopy group and 29 +/- 12.1 months in the surgery group. The results in both groups were evaluated by the short-term outcome involving morbidity, mortality and hospital stay, and the long-term outcome.Complications were more frequent in patients managed endoscopically than patients treated surgically[5 vs 2; p 0.21]. Duration of hospital stay was significantly longer in the surgery group than the endoscopy group [11.2 days vs 4.1 days; P<0.001]; even after considering repeated hospitalization for complications [11.4 daysvs 5.9 days; PO.001]. There was no hospital mortality in both groups. Surgery showed good long-term results in 70% of patients, fair results that required medical treatment in 20% of patients and poor results in one patient [10%]. Endoscopic management had good long-term results in 64% of patients, fair results in 18% of patients and poor results in 18% of patients. Overall, three patients [14%] showed poor results and were subjected to surgery for anastomotic stricture [one patient], restenosis after stent removal [another patient], or complete metal stent obstruction [the third patient].In conclusion, endoscopic biliary Stenting using plastic endoprosthesis in patients with benign biliary strictures has obtained good results and tolerable complications nearly equal to surgery. Endoscopic management is advised to be the first approach in such patients, and hepaticojejunostomy is indicated if endoscopic procedures fail or in case of recurrent stenosis. The use of metallic stents in benign biliary strictures has yet to be evaluated

Role of early laparoscopy in the management of acute abdominal pain of uncertain origin

This study was conducted on 33 patients [23 females and 10 males]. The outcome in both groups was assessed by diagnosis, total number of investigations done, duration of hospital stay, rate of readmission, morbidity and mortality and patient recovery. It was found that early laparoscopy obtained a higher diagnostic accuracy, decreased the readmission rate and provided an early return to normal activity in patients with acute abdominal pain of uncertain origin

Experimental schistosomiasis: the effect of chemotherapy on concomitant immunity and resistance to reinfection

To study the effect of chemotherapy on concomitant immunity, mice infected with Schistosoma mansoni were treated after either 8 or 16 weeks of primary infection and challenged at different periods after treatment. Results were compared to infected untreated groups of mice. It was found that in mice treated 8 weeks after infection the degree of protection decreased gradually with time and 16 weeks after treatment no significant degree of protection was obtained. On the other hand, mice infected for 16 weeks prior to treatment showed higher degrees of protection and there was still significant degree of resistance to challenge infection after 16 weeks of treatment. It was concluded that in schistosomiasis mansoni there is a certain degree of resistance to reinfection after successful treatment of primary infection prior to treatment