Serum hyaluronic acid level does not reliably differentiate minimal and significant liver disease in chronic hepatitis C

To evaluate the predictive value of hyaluronic acid [HA] for the assessment of liver fibrosis and inflammation in chronic hepatitis C [CHC]. This cross-sectional study was conducted at Ziauddin University, Karachi, Pakistan from June 2006 to July 2010. Ninety-eight CHC patients, 52 [53%] males, and 46 [47%] females, with an age range of 20-60 years [mean 36.0 +/- 10.5] were recruited. Liver fibrosis was staged on a 5-point scale, F0 to F4, and inflammation was graded on a 4-point scale, A0 to A3. Patients were divided into minimal [F<2 and A<2] and significant [F >/= 2 or A >/= 2] overall disease groups. The HA was measured in the serum by ELISA. Diagnostic value was assessed through receiver operating characteristic [ROC] curve. Significant liver disease was present in 46 [47%] patients. Mean serum HA was significantly different among severity groups [p=0.001]. Area under ROC curve for overall disease was 0.716. Negative predictive value [NPV] for significant overall disease remained 71% at a low HA level of 20 ng/mL. Positive predictive value [PPV] of 85% was obtained at 60 ng/mL and 100% at 120 ng/mL. Those high levels were present in 15% and 10% of the patients. Serum HA levels showed a low NPV for significant liver disease. An acceptable PPV was found only in a small proportion of the patients. Hyaluronic acid may not be regarded as a reliable marker for making treatment decisions

Estrogen receptors in human thyroid gland. an immunohistochemical study

Thyroid diseases affect women approximately 3 times more frequently than men. It has been suggested that the female sex steroids stimulate thyroid growth such as in the breast. Seventeen beta-estradiol, the major estrogen in the body acts via estrogen receptors [ER] present in the nucleus of the cell. The aim of the study is to determine the ER status in the thyroid gland tissues. Our study was based on immunohistochemical staining for ER. Fifty previously diagnosed cases of various thyroid lesions were selected from the Surgical Pathology Records of Pathology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, Pakistan between March and August 2000. The staining was performed on formalin-fixed paraffin embedded tissues using monoclonal anti-ER antibody [clone 1D5]. Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular and 4 cases were of medullary carcinoma. Surrounding normal tissue was available in 25 [50%] cases, 4 non-neoplastic and 21 neoplastic lesions. Out of 50 cases, 10 [20%] were males and 40 [80%] were females, the youngest patient was a 14-year-old female and the eldest patient was a 56-year-old male. Despite the availability of normal thyroid tissue and a wide range of lesions, none of our cases showed positive staining. In contrary to many earlier reports by immunohistochemical method using monoclonal antibody [clone 1D5] on formalin-fixed paraffin-embedded thyroid tissues, the ER are not detectable. The effect of estrogen on thyroid gland may be indirect one