Evaluation of serum interleukin-6 level as a screening/diagnostic marker for patients with nasopharyngeal carcinoma: a comparative study versus Epstein - Barr virus plasma load estimation

The present study was designed to evaluate serum levels of interleukin-6 [IL-6] in pre-treatment samples obtained from patients with biopsy confirmed nasopharyngeal carcinoma [NPC] and to correlate it with Epstein-Barr [EBV] DNA plasma load estimated using quantitative PCR, tumor clinical staging and pathological grading so as to determine its applicability as a screening and/or diagnostic marker for NPC. The study comprised 30 patients had biopsy confirmed NPC and 10 healthy volunteers as control for estimated serum IL-6. Patients were subjected to full history taking, complete clinical examination, nasopharyngoscopy and imaging studies. Blood samples were collected prior to and after completion of chemo-radiotherapy course for qualitative identification and quantitative estimation of EBV DNA plasma load and, estimation of serum IL-6. Ten patients were clinically staged II, 12 patients had stage III lesions and 8 patients had stage IV lesions. Histopathologically, 14 specimens were of WHO type 1, 10 specimens of WHO type 2 and 6 specimens WHO type 3. Qualitative PCR could detect EPV-DNA, in all blood samples and mean pre-treatment EBV DNA plasma load was 2126.2 +/- 665; range: 1098-3248 copies/ml. The mean pre-treatment serum IL-6 was 175.6 +/- 32.8; range: 128-235 ng/ml and was significantly higher than control levels. Mean serum IL-6 was significantly higher in patients clinically staged IV compared to those staged II and III and was significantly higher in patients with lesions type 3 compared to those with lesions type 1 and 2. Mean EBV DNA plasma load was significantly higher in patients staged IV compared to those staged II and III but showed non-significant difference between pathological types. There was a positive significant correlation between estimated serum IL-6 levels and EBV DNA plasma load, [r=0.428, p=0.018], TNM clinical staging of the lesion, [r=0.432, p=0.017] and WHO pathological type, [r=0.513, p=0.004] and between estimated EBV DNA plasma load and TNM clinical staging of the lesion, [r=0.604, p=0.026], but the correlation was non-significant [r=0.344, p>0.05] with WHO pathological type. Evaluation of the specificity of both serum IL-6 and EBV DNA load as a predictor for pathological grade using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] revealed a non-significant difference in the specificity of both parameters for prediction of pathological grade of lesion. Post-treatment mean serum level of IL-6 and EBV DNA plasma load were significantly lower compared to pre-treatment level. In conclusion, estimation of serum IL-6 could be used as a screening test for detection of cases of NPC among suspicious patients and as a diagnostic test for cases with established NPC

Viral hepatitis c infectivity of nasal secretion: PCR evaluation

The present study aimed to evaluate the prevalence of hepatitis C virus [HCV] infection in nasal lavage [NL] fluid of patients had no history of previous HCV infection. The study was designed as a 2-arm screening study: Group N included 200 randomly chosen patients and started by testing NL fluid for presence of anti-HCV antibodies [anti-HCV Ab] and those with positive result underwent determination of sero-positivity. The other arm consisted of another patients' group [Group S; n=200] underwent determination of sero-positivity, and those proved positive underwent determination of positivity of their NL fluid for anti-HCV Ab. PCR identification of HCV RNA was conducted for all positive sera and NL fluid. Anti-HCV Ab were detected in NL fluid of 7 patients with detection rate of 3.8% and in serum samples of 10 patients with a detection rate of 5% and an overall detection rate of patients with anti-HCV positive of 4.4%. The 7 patients with anti-HCV Ab positive NL fluid were sero-positive; while only 6 of the 10 sero-positive patients had anti-HCV Ab positive NL fluid, thus, determination of anti-HCV Ab in NL fluid could detect sero-positive patients with sensitivity rate of 76.4%. Qualitative PCR detection of HCV-RNA identified viral RNA in 14 serum samples; 13 samples were sero-positive and NL fluid positive and one was sero-positive but NL fluid negative, while the other 3 sero-positive samples were free of viral RNA. Thus, NL fluid anti-HCV Ab positivity could identify patients with viremia with sensitivity and accuracy rates of 92.8% and 94.1%, respectively and could exclude the presence of viremia with a negative predictive value of 75%. Using ROC curve analysis, defined determination of positivity of NL fluid as specific predictor for the presence of viremia with AUC=0.673, while sero-positivity showed AUC=0.500. To evaluate the infectivity of NL fluid, PCR identification of HCV viral R1VA in NL fluid was conducted for all NL fluid samples proved positive for antibodies and could detect HCV-RNA in 3 samples with infectivity rate of 17.6%.. It could be concluded that positivity for anti-HCV Ab was detected in 4.4% of the studied population supposed to be free of HCV infection and anti-HCV Ab determination in NL fluid could predict viremia with accuracy rate of 94.1% and could be considered as specific predictor with AUC=0.673 with an infectivity rate of NL fluid was 17.6%

Serum S100B and neuron-specific enolase as predictors of the neurologic disability status after traumatic brain injury

This study was designed to evaluate the correlation between serum levels of protein S100B and neuron-specific enolase [NSE] and the severity and outcome of traumatic brain injury [TBI] so as to be used as prognostic markers for cases admitted to Intensive care unit [ICU] after TBI. The study comprised 40 patients with head injury of varied severity and 10 volunteers [control group]. Inclusion criteria were head injury and presentation to the emergency department within 6 hours of injury. Initial injury severity was assessed using the Glasgow coma score [GCS] and all patients had cranial CT scans and lesions were evaluated with respect to lesion topography and territories of vascular supply. A venous blood sample was collected at admission for estimation of serum protein S100B and NSE levels. All patients received measures to decrease intracranial pressure [ICP] and phyntoin for posttraumatic seizures and underwent the appropriate neurosurgical procedure according to type of post-traumatic lesion. Follow-up was conducted monthly and the final outcome at six months was assessed using the Expanded Disability Status Scale [EDSS]. The mean initial GCS score was 11.1 +/- 3; 14 patients [35%] had mild, 17'patients [42.5%] had moderate and 9 patients [22.5%] had severe trauma. Normal CT was reported in 14 patients [35%]; however, CT scanning detected extradural hemorrhage in 5 patients [12.5%] fissure skull fracture in 5 patients [12.5%], fissure basal skull fracture in 3 patients [7.5%] and depressed skull fracture in 2 patients [5%]; while 3 patients [7.5%] had intracerebral hemorrhage and the other 8 patients had subdural hemorrhage, subdural hemorrhage with contusion, subdural hematoma and subarachnoid hemorrhage. Throughout follow-up, 18 patients [45%] had favorable outcome [EDSS<5]; while 22 patients had unfavorable outcome with EDSS >/= 5. Serum levels of S100B and NSE were significantly [P[1]<0.05] increased in patients compared to control levels, moreover, mean serum level of S100B was significantly [P[2]<0.05] and of NSE was non-significantly [P[2]>0.05] higher in patients with unfavorable outcome [EDSS >/=] compared to those with favorable outcome [EDSS<5] with a positive significant correlation between serum levels of S100B and NSE, [r = 0.485, p = 0.002]. Moreover, serum levels of both parameters showed a negative significant correlation with the initial GCS while showed a positive significant correlation with EDSS. However, there was a negative correlation between both parameters and the final outcome as favorable or unfavorable; such correlation was significant with S100B and non-significant with NSE. Using Logestic regression analysis serum S100B was the most significant predictor of the final outcome, [beta =-0.371, p = 0.018]. Receiver operator characteristics [ROC] curve analysis for serum levels of both S100B and NSE for prediction of favorable outcome found serum levels of S100B more specific with an area under curve [AUC] =0.379 than serum levels of NSE that found to be more sensitive with an AUC = 0.294. It could be concluded that estimation of serum S100B and NSE immediately after traumatic brain injury could define patients who will develop unfavorable outcome and posttraumatic disability with high sensitivity with NSE and specificity with S100 and must be used for the initial evaluation of TBI irrespective of the extent of severity of inflicted trauma

Umbilical cord blood procalcitonin as an early predictor of early-onset neonatal sepsis in premature neonates: a comparative study versus C-reactive protein

This study aimed to compare the efficacy of umbilical cord blood levels of procalcitonin [PCT] and C-reactive protein [CRP] as early predictors of early-onset sepsis [within 72 hours since delivery] in premature neonate admitted to NICU. The study included 88 preterm neonates with mean gestational age of 33.8 +/- 3; range: 29-38 weeks and mean birth weight of 1955 +/- 234; range: 1480-2350 gm with a mean 5-min Apgar score was 7.7 +/- 1.1; 7 neonates were small-for-gestational age and 23 neonates required resuscitation at birth. Neonates were categorized according to the presence of sepsis into two groups: Infected neonates had clinical manifestations of sepsis and positive blood culture and Non-infected neonates showed no clinical manifestations and had negative blood culture at 72 hours since delivery. Two blood samples were obtained: umbilical cord blood samples obtained at time of admission to NICU for estimation of serum CRP and plasma PCT and a venous blood sample was obtained either at time of development of clinical signs of sepsis or at 72 hours since delivery in non-infected groups for blood culture and complete blood count [CBC] to assure the clinical diagnosis of infected cases. Sixty neonates [68.2%] developed clinical signs of sepsis and proved by blood culture to be infected. The mean levels of CRP and PCT estimated in umbilical blood sample obtained at time of admission to NICU were significantly higher [p<0.05] in infected compared non-infected neonates. Calculation of diagnostic validity characters of each cutoff point defined plasma PCT cutoff at >0.6 ng/ml as the appropriate value for exclusion of neonatal sepsis with 100% sensitivity and negative predictive value [NPV] and specificity rate of 93% and accuracy of diagnosis with rate of 97.7%. Comparison of the diagnostic validity characters of umbilical cord plasma PCT [at cutoff point of >0.6 ng/ml] and umbilical cord serum CRP [at cutoff point of >10 mg/l] as an early predictor of development of neonatal sepsis showed a significant difference in favor of plasma PCT, [X2= 3.19, p<0.01]. It could be concluded that estimation of plasma PCT in umbilical cord blood of preterm neonates could be used as an early specific and sensitive predictor for the possibility of development of early-onset neonatal sepsis at NICU and plasma PCT level at cutoff point of >0.6 ng/ ml is appropriate for identification of neonates at risk of developing sepsis with 100% sensitivity and negative predictive value

Surgical impact on serum levels of insulin-like growth factor-1, insulin-like growth factor binding protein-3 and interleukin-6 in patients undergoing laparoscopic cholecystectomy: a comparative study versus open cholecystectomy

This study aimed at estimation of serum levels of insulin-like growth factor-1 [IGF-1], insulin-like growth factor binding protein-3 [IGFBP-3] and interleukin-6 [IL-6] in patients undergoing open [OC] or laparoscopic [LC] cholecystectomy so as to evaluate the impact of surgical procedure on their serum levels. The study comprised 30 patients [7 males and 23 females] assigned to undergo cholecystectomy for calcular cholecystitis. Laparoscopic cholecystectomy was performed according to the European "four-puncture" technique Blood samples were taken preoperatively and one [POD1] and 2 [POD2] days after surgery for determination of complete blood picture and estimation of serum IGF-1, IGFBP-3 and IL-6. The mean operative time was non-significantly prolonged in LC group, while, the mean wound length and duration of postoperative hospital stay were significantly [p<0.05] decreased in LC compared to OC group. Total leucocytic count [TLC] and the percentage of neutrophils showed progressive increase in both groups at POD1 and POD2 compared to preoperative counts; leucocytosis and neutrophilia were significant [p<0.05] at POD2 compared to levels estimated at POD1 in OC group but were non-significant in LC group and were significantly [p<0.05] higher in OC group compared to LC group at both POD1 and POD2. Serum IGF-1 was significantly [p<0.05] decreased in both groups at both POD1 and POD2 in comparison to preoperative levels, with a significant [p<0.05] increase at POD2 compared to levels estimated at POD1 in LC group, while the difference was non-significant [p>0.05] in OC group. Moreover, serum IGF-1 was significantly [p<0.05] higher in LC compared to OC group at both POD1 and POD2. Serum IGFBP-3 was decreased significantly [p<0.05] in OC group and non-significantly [p>0.05] in LC group in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] decrease in OC group compared to LC group at both PODI and POD2. Serum IGFBP-3 showed progressive decrease but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. Serum IL-6 was increased significantly [p<0.05] in both groups in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] increase in OC compared to LC group at both POD1 and POD2. Serum IL-6 showed progressive increase but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. There was a positive significant correlation between serum IL-6 and percentage of neutrophils at POD1 in both groups and a positive correlation with percentage of neutrophils at POD2 that was significant in OC group but was non-significant in LC group. Moreover, serum IL-6 levels showed a negative correlation with serum IGFBP-3 at both POD1 and POD2 that correlation was significant in OC and non-significant in LC group. It could be concluded surgery induces postoperative increased serum levels of IL-6 associated with decreased levels IGF-1 and IGFBP-3, such effect was minimized in patients underwent laparoscopic surgery and explain the shortened postoperative catabolic stage