Assessment of esophageal motility disorders in chronic renal failure

In patients with chronic renal failure [CRF] anorexia, nausea, and vomiting are common yet poorly understood symptoms. The study aimed to examine motor function disturbances of the esophagus as well as modulating hormonal factors and its effect on nutritional status in patients with [CRF] .We studied 50 patients stratified into 3 groups: G1: 25 patients with [CRF], on hemodialysis, G2: 25 patients with [CRF], on conservative treatment and G3: ten subjects with abnormal upper GI. Manifestations, but with normal renal functions. S. gastrin and S. albumin were examined in all groups and esophageal manometric assay was done for all. At presentation G1: showed the presence of elevated lower esophageal sphincter pressure and incomplete lower sphincter relaxation with elevated residual pressure on relaxation associated with low percentage of relaxation on wet swallows. In addition to a high amplitude and prolonged duration of esophageal contractions as compared to G3, this was associated with hypergastrinemia and low S. albumin. Moreover G2: showed the same results as for G1, plus a high percentage of uncoordinated contractions as compared to G3, but it lacks high amplitude and prolonged duration of esophageal contractions . We conclude that esophageal motility abnormalities and elevated serum gastrin may be a consequence of [CRF], in addition, elevated serum gastrin may play an important role in initiating these abnormalities and that esophageal manometry should thus be considered for patients with CRF presenting with gastrointestinal upsets

Evaluation of plasma adiponectin level in patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease is an increasingly recognized condition that may progress to end stage liver disease; the aim was to study the level of plasma adiponectin in patients with nonalcoholic fatty liver with DM, and chronic hepatitis C in comparison with a control group. The study was conducted on 60 individuals, 37 males and 23 females, their age ranged from 26 to74 Ys, they were categorized into 3 groups: G 1: 20 apparently healthy individual serving as a control group, G2: 20 patients with type 2 DM and fatty liver, G 3: 20 patients with chronic hepatitis C and fatty liver. All cases underwent full clinical examination and laboratory investigaions, including [CBC], [ESR], liver and kidney- function tests ,fasting and 2hours PP blood glucose, lipograms, Polymerase chain reaction [PCR] for HCV-RNA in addition to abdominal ultrasonography and estimation of serum adiponectin level by ELISA technique. A significantly decreased plasma adiponectin levels were found in patients with fatty liver disease when compared to the control group. In addition, plasma adiponectin in group 2 [DM] show significant positive correlation with fasting blood glucose level [r =-52, p<0.05]. However plasma adiponectin levels, were significantly lower in group 3 [HCV] than in the other groups. A significant lower adiponectin levels was observed in male in all groups, further more plasma adiponectin in group 3 [HCV] show significant spositive correlation with blood urea [r =0.48, p <0.05] and HDL level [r =0.49, p <0.05]. Plasma adiponectin level is decreased in patients with NAFLD with type2 DM and chronic HCV and may suggest fat accumulation in the liver

Correlation between clinical presentation and genotypes of human giardiasis

The aim was to study the genotypes of human giardiasis and its relation to the symptoms of the clinical presentation. 105 patients. with giardiasis In the stool, 61 were symptomatizing and 44 were asymptomatic. and 20 subjects serving as a control group with negative stool examination for giradiasis. all were examined by PCR of stool to detect genotypes of G.L. PCR detected G.L. in 73.3% and failed to detect G.L in 26.7% of cases with G.L. in stool, and was negative in all control subjects. this mean. RCR specificity is 100% and sensitivity 73.3% for G.L. Three genotypes were detected, genotypes I in 36.19%. genotype II in 12.38% and genotype III in 9.52%, and mixed genotypes were detected in 15%, of cases with G.L In the symptomatic patients genotype I was 32.79%, genotype II was 16.39% and genotype III was 9.64%, mixed genotypes infection in 16.39% and undetermined genotypes was 24.59% while in the asymptomatic group. genotype I detected in 40.91% genotype II In 6.82%. genotype II in 9.59% mixed genotypes in 13.64% and undetermined in 29.55%. There was no statistically significant difference between symptomatic and asymptomatic group regarding G.L genotype distribution and the genotype of G.L was not related to symptoms of clinical presentation. the study revealed genetic diversity of G. Lamblia infection in the studied population and the genotypes of G. Lamblia were not related to the symptoms of clinical presentations

Serum gamma INF inducing factor [IL18] levels in patients with chronic liver disease

Interleukin 18 [IL18] is likely to play a role in inflammatory liver disease, it is currently regarded as the primary inducer of INF gamma in inflammatory reaction, in chronic hepatitis C a significant up regulation of IL 18 in the inflammatory infiltrate has been demonstrated. The study aimed to evaluate the serum levels of IL18 in patients with chronic liver disease and to assess its role in the clinical outcome of patients with liver injury. The cohort consisted of 60 subjects age ranged from 32-65 ys, they were stratified into 4 groups; G1: 15 patients with chronic liver diseases. G2: 15 patients with liver cirrhosis G3: 15 patients with Hepatoma. G4: 15 healthy subjects serving as control Beside full routine laboratory tests. The patients were tested for autoantibodies [ANA,SMA, AMA] ,viral markers and determination of IL18 serum by ELISA. At presentation a significant increase of serum IL18 was found in all groups compared to control in addition IL18 was significantly higher in G3 than G2, furthermore it was significantly higher in G2 than G1. Moreover IL18 showed also a significant positive correlation with AST, ALT,TB,DB. in contrast a negative correlation was detected with albumin and PT It can be concluded that IL18 is likely to be involved in the pathogene-sisof human liver diseases

Peripheral neuropathy in hepatitis C patients in Egypt

The overall prevalence of HCV antibodies in the general population is around 10-15% and is highly prevalent among Egyptian blood donors. The study was carried out on 30 patients, there was [21 male and 9 were female] age ranged from 27-62 ys with proved HCV infection by means of positive antibody assay for the virus and positive PCR for HCN RNA. The current study aimed to evaluate the role of HCV in peripheral neuropathy [PN] and to assess the response of PN to medical treatment PN was assessed clinically by motor and sensory examination. Beside routine clinical and laboratory tests, electrophysiological studies were also done. At presentation, sensory axonal degeneration neuropathy was the most prevalent type of neuropathy in the studied HCV subjects, in addition male HCV -patient are slightly more subjected to the development of HCV- associated peripheral neuropathy furthermore. Peroneal nerve conduction velocity was found to be impaired more than that of median nerve. Interestingly the presence of ascites had no significant effect on the degree of nerve conduction. The underlying mechanism of such peripheral neuropathy is mostly due to axonal degeneration. We therefore conclude that HCV- associated neuropathy had mainly a chronic evolution. PN manifestations can be the initial presenting manifestation of HCV infection

Bleeding tendency in liver cirrhosis: Is there a role for vascular endothelial growth factor

Liver cirrhosis [LC] represents a very special and important problem in Egypt because of endemicity of bilhareziasis and its complications. Patients with liver cirrhosis have high bleeding tendency and they may develop petechies, ecchymosis, gastrointestinal bleeding, bleeding gum, epistaxis.etc. Many factors are proposed to explain this bleeding tendency in liver cirrhosis of which platelets abnormalities and alterations of both coagulation and fibrinolytic systems are the most appreciable. Epistaxis is one of the presentation of patients with liver cirrhosis. Nasal mucosal changes were found to be extensive in liver cirrhosis and these changes could not be explained upon the mentioned bleeding abnormalities only. A further pathogenic factor controlling angiogenesis may be added. Vascular Endothelial Growth Factor [VEGF] was claimed to take a part in this situation as it is one of the most important angiogenetic factors in the body. Our study focused to clear up the clinical significant of serum level of VEGF and possible nasal mucosal changes [NMC] as an example for bleeding tendency in such patients. The study included 45 patients with LC and 20 healthy controls. Patients are classified according to Child classification into three groups. Bleeding tendency in the form of epistaxis was the main complaint in a good ratio of patients and it was found to be correlated with vascular nasal changes even in patients with normal bleeding profile in those patients. Serum level of VEGF was directly proportional to the staging of L.C. Our results suggest that VEGF may have a significant new possible role for bleeding tendency in patients with L.C. as shown from its more expression and significant effect on nasal mucoas and submucosa in the form of organization, vascularization and other changes of nasal granulation tissues of those patients. These changes were found to be more and more with progression of the disease