ABSTRACT
Background: In Egypt, the prevalence of hepatitis C virus infection is high [about 20%]. Chronic hepatitis C [CHC] is a slowly progressive disease complicated by liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Treatment of CHC with pegylated interferon-alpha [peg-IFN-alpha]/ribavirin [RBV] combination therapy was the standard of care therapy until 2014 and is used until now in some regimens with new direct acting antiviral drugs. Some hepatitis C virus proteins [core, E2, NS4A, NS5A, and NS2] induce interleukin-8 [IL-8], which inhibits the antiviral activity of IFN-alpha. It was found to be significantly higher in patients with nonsustained virological response [non-SVR] than in patients with SVR to IFN/RBV therapy. IL-10 is a Th2 cytokine, and an imbalance between Th1/Th2 immune response could influence the clinical course of CHC and response to treatment. Some studies showed that pretreatment IL-10 serum level is much higher in patients with non-SVR than in those with SVR to therapy and could be considered as a good predictor for response to IFN/RBV therapy
Aim of the work: The aim of the study was to determine pretreatment serum levels of IL-8 and IL-10 in Egyptian CHC patients and their value in the prediction of response to peg-IFN/RBV therapy
Patients and methods: This study included 75 CHC Egyptian patients and 14 healthy individuals [control group]. Pretreatment serum levels of IL-8 and IL-10 were measured and then CHC patients were subjected to peg-IFN/RBV therapy
Results: SVR was achieved in 64% of treated CHC patients, whereas 36% were non-SVR. Serum levels of IL-8 and IL-10 were significantly lower in controls than in CHC patients and in the SVR than in the non-SVR group
Conclusion: We can consider serum IL-8 and IL-10 pretreatment levels as good predictive noninvasive markers to predict SVR to peg-IFN and RBV therapy in CHC patients
ABSTRACT
Despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes. Asthma, gastro-oesophageal reflux disease [GERD] and upper airway cough syndrome [UACS] are common causes for chronic cough with a normal chest X-ray [CXR]. To describe the frequency of these three causes in a cohort of outpatients with chronic cough and normal CXR and to identify the diagnostic tests best able to identify the aetiology in the vast majority of cases using the response to specific therapy as a gold standard. Nonsmoking outpatients of both genders who complained of cough for more than 8 weeks and had normal findings on CXR were studied prospectively. All patients were subjected to spirometery [including postbronchodilator reversibility], sinuses CT scan, rhinoscopy, and 24-h esophageal pH monitoring to get "an initial diagnosis". The assumed causes were confirmed by treating them sequentially. "The final diagnosis" depended on a successful response to therapy. Hundred patients were studied: the laboratory tests established initial diagnoses of asthma, UACS, GERD, or various combinations of these in 78 patients, of those; 35 patients [44.9%] had a single cause, 39 patients [50%] had two causes, and 4 patients [5.1%] had all three causes. After treatment of those 78 patients, the final diagnoses were established as follow: 47 patients [60.3%] has a single cause, 28 patients [35.9%] had two causes and 3 patients [3.8%] had all three causes. There was a good agreement between the laboratory tests and the definite causes [agreement in 65 patients [83%] and discrepancy in 13 patients [17%], k > 0.75]. Twelve patients had their diagnoses changed for two causes to a single cause and one patients had the diagnosis changed from three causes to two causes. Asthma, UACS, GERD, or some combination of these represent 78% of the causes of chronic cough in our sample. Therefore, these conditions should be considered first during diagnostic evaluation of patients with chronic cough and normal CXR. Inspite of some discrepancy between initial and final diagnoses, the study identifies the group of diagnostic methods best able to identify the cause in the vast majority of cases of chronic cough including sinuses CT scan, rhinoscopy, pulmonary function tests, and esophageal pH monitoring