Free serotonin [5-HT] levels in Egyptian patients with esophageal and fundal varices

Background: Serotonin appears to be a central physiologic mediator of many gastrointestinal functions and a mediator of the brain-gut connection

Aim: The aim of this study was to determine concentrations of free serotonin in plasma in patients with and without esophageal and fundal varices

Participants and methods: Patients diagnosed with stigmata of chronic liver disease [history, clinical, laboratory, and radiological findings - e.g. jaundice, lower limb edema, hepatomegaly, and splenomegaly] and presenting with gastrointestinal symptoms were included in the study. After upper gastointestinal endoscopy, patients were divided into two groups: group I included 30 patients with liver cirrhosis complicated with varices and group II included 30 patients with liver cirrhosis who did not have varices. Thirty healthy participants served as the control group. All patients were subjected to history taking, clinical examination, laboratory tests, abdominal ultrasound, and upper gastrointestinal tract endoscopy [for group I and II]. Plasma free serotonin was measured by the ELISA test

Results: All groups were age-matched and sex-matched. Estimation of plasma free serotonin showed a highly statistically significant difference between groups [F=59.32, P<0.01]. A serotonin cutoff value of 24 ng/ml was chosen, with 100% sensitivity, 96.7% specificity, 98.3 to discriminate all chronic liver disease patients from healthy controls [area under the curve=0.981]. A cutoff value of 58.0 ng/ml to differentiate between patients with and without esophageal varices, with 80% sensitivity and 86.7% specificity [area under the curve=0.855]. A highly significant stepwise progressive increase in the marker level was recorded through grades of oesophageal varices 2-5 [stage 2, 20.7 +/- 7.7 ng/ml; stage 3, 44.3 +/- 8.9 ng/ml, P<0.01; stage 4, 100.1 +/- 12.4 ng/ml, P<0.01; stage 5, 114.6 +/- 14.7 ng/ml, P<0.05]. There was highly significant difference in plasma free serotonin levels in patients with esophageal and gastric varices compared with those with esophageal varices alone

Conclusion: Plasma free serotonin levels could possibly be used as a noninvasive predictive method for the presence of gastroesophageal varices

Novel prognostic biomarkers for HCC progression in Egyptian patients

Objectives: To evaluate values of Cyclin D and Cdk4 in HCC, chronic hepatitis C, HCV related liver cirrhosis and healthy controls, their clinico-radiological correlations and prognosis of HCC

Methods: Group 1: Fifty patients with HCC, Group 2.Fifty patients with chronic hepatitis C with or without cirrhosis and Group 3: Thirty healthy controls were enrolled. All patients were positive for hepatitis C virus [HCV] antibody and confirmed by HCV RNA. Calculation of Barcelona-Clinic Liver Cancer [BCLC] staging system, MELD and Child-Pugh scores. mRNA for cyclin Dl and Cdk4 were analyzed by quantitative RT-PCR

Results: The mean Cyclin Dl and Cdk4 values were higher in HCC group compared with the other two groups [p value= 0.001]. In HCC group, the mean Cdk4 and cyclin Dlvalues were significantly higher among HCC patients with multiple hepatic focal lesion [HFL] [p value= 0. 0001, and003 respectively] compared with those with single lesion. A significant correlation between size of [HFL], alpha-Fetoprotein[AFP] and mean Cdk4 value [p value= 0.028, 0.0001 respectively]

Conclusions: Significant values of cyclin Dl and Cdk4 were found in HCC, compared to normal and chronic hepatitis C and correlated to the number, size of HFL and AFP level. Thus, the assessment of cyclin Dl and Cdk4 may provide a novel strategy for prognostication and targeted therapy of HCC

IgG-index as early predictor for neurological morbidity in Egyptian patients with acute meningitis

Diagnostic procedures to predict the prognosis of acute meningitis are of paramount importance in order to choose the appropriate level of further surveillance. The aim of this study was to evaluate the predictive power of IgG-ndex as CSF biomarker for disease prognosis in patients with acute meningitis. This is a prospective study done on forty patients; group I: Twenty patients with the clinical diagnosis and CSF analysis of acute bacterial meningitis and group II: Twenty patients with the clinical diagnosis and CSF analysis of aseptic meningitis. All the patients were subjected to routine clinical and laboratory evaluation and complete CSF analysis. Intrathecal IgG synthesis was measured using radial immunodiffusion [RID] technique. Glasgow outcome scale [GOS] was done at discharge. The duration of hospital stay was recorded. The IgG-index was the only independent predictor for unfavorable outcome [GOS <5] in patients' groups' especially aseptic group. The best cut off value of IgG index for early prediction of unfavorable outcome [GOS <5] in bacterial meningitis group was >/=6.75 with AUC of 0.922 and 95% CI of 0.769-1.07 and sensitivity of 75% and specificity of 93.7%. While, in aseptic meningitis group was >/=7.9 with AUC of 1 and 95% CI of 1.00-1.00 and sensitivity of 100% and specificity of 100%