TGF-B1 IN PATIENTS WITH CHRONIC HBV INFECTION

The transforming growth factor-beta[1] is an important cytokine with anti-inflammatory properties may have a role in pathogenesis of liver fibrosis. The main purpose of this study was to compare the serum levels of TGF- beta[1] in a group of chronic HBV infected [CHB] patients as well as healthy individuals and to determine the correlation between the TOF- beta[1] and stages of fibrosis in CHB patients. A case control study using forty patients with CHB as well as forty healthy individuals. ELISA technique was applied to measure the serum level of TGF- beta[1] in both patient and control groups. We used the data of the liver biopsy of CHB patients to make a correlation between TGF- beta[1] and stages of fibrosis. Our results revealed that the serum levels of TGF- beta[1] -were significantly increased in CHB patients [1958.0 +/- 730.26pg/ml] in comparison to healthy controls [944.4 +/- 5 73.24 pg/ml] [P<0.0001]. Serum levels of TGF- beta[1] -was significantly increased in F2-F3 [2600.0 +/- 472.69pg/ml] in comparison to FO-F1[1483.5 +/- 478.54 pg/ml] [P < 0.0001]. The sludy concluded that high serum levels of TGF-fl may be a mechanism by which immune response against IIBV is suppressed. The serum level of TGF- beta[1] is a potential noninvasive marker for diagnosis of liver fibrosis in CHB patients

Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were: ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial: echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF

Cardiac arrhythmias and silent myocardial ischemia in chronic renal failure patients on hemodialysis

Cardiovascular diseases are the most common cause of death in patients with End Stage Renal Disease [ESRD] on renal replacement therapy. Cardiac arrhythmias are frequent cardiovascular complication during dialysis session. ST segment depression on ambulatory ECG without patient awareness is a marker of what has been termed "silent ischemia". It has been suggested that in patient with ESRD transient ST segment depressions are associated with increased cardiovascular mortality. The objective of this study is to evaluate and to detect the effect of hemodialysis on cardiac rhythm in ESRD patients on regular hemodialysis by using Holler's monitor [24 hours. ambulatory electrocardiogram] and also to detect prevalence of silent myocardial ischemia among these patients. This study was conducted in the Dialysis Unit, Sohag University Hospital, Sohag Faculty of Medicine. It included 40 adult patients [29 males and 11 females] with ESRD on regular hemodialysis. Their ages ranged from 18-50 years with a mean age of [35 +/- 2.36] years. Results of this study showed that there is runs of ventricular and supraventricular arrhythmia in dialysis patients and the occurrence of this arrhythmia in the form of insignificant ventricular runs which occurred in 2 [5%] out of 40 patients studied. However there is a significant prevalence of total ventricular arrhythmia which occurred in 80% of the patients. There is significant occurrence of supraveniricular arrhythmia which occurred in 62.5%, 42.5% and 40% [predialysis, during dialysis and postdialysis respectively]. Ventricular tachycardia was not seen, and supraventricular was observed in 5 patients [12.5%]. The total number of these arrhythmias [both ventricular and supraventricular] were improved by hemodialysis. The present study showed that there is a high incidence of myocardial ischemic episodes in relation to hemodialysis. 29 [72.5%] out of 40 patients showed ischemic episodes of whether 24 [83%] patients showed asymptomatic ischemic episodes. The study also showed that most ischemic episodes whether painful or silent were recorded during hemodialysis session [72.8%]. Dialysis per se is not arrhythmogenic. The isolated ventricular and atrial arrhythmias occurred in patients with ESRD cluster before next hemodialysis sitting are assumed to be due to disturbances of both serum phosphorus and serum potassium levels. On the other hand myocardial ischemic episodes frequently occurred during hemodialysis