Diagnostic value of antisoluble liver antigen/ liver pancreas antigen [SLA/LP] and other autoantibodies in the diagnosis of patients with autoimmune liver disease

This study aimed to evaluate the role of auto antibody profile in the diagnosis of patients with suspected autoimmune liver disease and their ability to define the putative type 3 autoimmune hepatitis [AIH]. Forty adult patients with abnormal liver function, elevated serum IgG and negative hepatitis markers were chosen from those attending the Hepatology Clinic and Internal Medicine Clinic of Alexandria Main University Hospital and Armed Forces Hospital. According to the results of liver biopsy, 36 patients were diagnosed as AIH, one patient as primary biliary cirrhosis [PBC] and the other 3 patients were still undiagnosed. Also, 10 patients with documented diagnosis of non-immune hepatitis B virus in addition to 10 age and sex matched healthy controls were enrolled in this study. Autoantibody profile of ANA, ASMA, AMA, LKM and p-ANCA was measured by indirect immunofluorescent technique [IF] and anti SLA/LP, LKM-1, LC-1 and AMA-M2 autoantibodies were detected by western blot assay. The sensitivity of ANA, ASMA, AMA, LKM, p-ANCA, SLA/LP and LC-1 were 48.6%, 51.4%, 2.7%, 8.1, 56.8%, 18.9% and 10.8% respectively with high specificity [100% for all auto-antibodies except that for ANA 95.7% and ASMA 87%]. However, the overall sensitivity of the complete profile was increased to 100% and specificity was 91.3% from this study we conclude that a complete profile of autoantibodies can be used as a useful tool for the diagnosis of patients with suspected autoimmune liver disease. Anti SLA/LP is an additional specific and diagnostic marker for the diagnosis of AIH type 1 and it remains to be seen whether the seropositivity of SLA/LP may characterize the patients who are more likely to relapse after corticosteroid therapy

Helicobacter pylori infection: relation to protein losing enteropathy in malnutrition

This work was carried out to study the prevalence of Helicobacter pylon [H-P] infection in malnourished children and to prove the association -if any- between H-P infection and protein losing enteropathy [PLE] in these children. Stool samples of 100 children ranging in age from 3 to 24 months were studied. Those children included 40 under weight children, 40 marasmic children and 20 age and sex matched well nourished children as a control group. Stools from malnourished and control children were tested for H-P antigen and focal concentration of alpha 1- antitrypsin [FA-AT] using ELISA technique. Measurement of both parameters was repeated in H-P positive children 2 weeks after eradication therapy of H-P infection. The results proved that the prevalence of H-P infection amounted to 53% of malnourished children compared to 20% of control group. The mean values of FA-AT were significantly higher in malnourished children with positive H-P infection than those with negative infection [P <0.0001]. Following the eradication therapy of H-P infection, the mean values of FA-AT showed a significant decrease [P < 0.0001]. However, these values were still higher than those of the control group [P <0.0001]. H-P infection is an important co-factor in the etiology of some aspects of protein energy malnutrition [PEM]. H-P infection plays also a leading role in the pathogenesis of PLE and its therapeutic eradication can reverse some of these findings

Evaluation of plasma elastase, D-dimer and fibrin degradation products in comparison to doppler ultrasonography in the diagnosis of patients with deep vein thrombosis

The present work aimed at evaluating the usefulness of plasma elastase, D-dimer and fibrin [ogen] degradation products [FDPs] in comparison with doppler ultrasonography for the diagnosis of deep vein thrombosis [DVT] among 20 adult patients who were admitted to the emergency unit of Alexandria main University hospital with symptoms and signs suggestive of DVT. 10 healthy age and sex matched controls were also enrolled in this study. Plasma elastase, D-dimer were estimated by ELISA technique while FDPs by semiquantitative latex agglutination. They were done at presentation and 10 days after heparin therapy while they performed once in control group. It was found that the mean values of plasma D-dimer elastase and FDPs were significantly higher than those in control group both before [P[1]< 0.0001] and after therapy [P[2]< 0.0001] respectively. Post heparin therapy, the mean values of same parameters were significantly decreased when compared with pretreatment mean values using paired t-test [p= 0.000] for D dimer, elastase and FDPs respectively. As regards the extent of thrombus diagnosed by doppler ultrasonography, there was a significant increase in the mean values of D-dimer in proximal and all DVT than those in distal DVT while there was no significant difference between plasma elastase and FDPs and the extent of thrombus. A significant positive correlation was found between plasma D-dimer and elastase both before [r=0.845, p=/< 0.0001] and after heparin therapy [r= 0.764, p= 0.000]. No significant correlation was found between FDPs and the previous two parameters neither before nor after treatment. Doppler ultrasonography is a definitive test for diagnosis and localization of thrombus in DVT. Plasma D-dimer, elastase and FDPs can be used for initial evaluation of DVT suggestive patients in the emergency unit and further studies are needed to clarify their role in predicting the recurrence of DVT

Diagnostic value of PRO C global test in patients with deep vein thrombosis

This study was carried out to evaluate pro C Global [PCG] test in clinical routine with special regard to its sensitivity and specificity for factor V [FV] leiden as well as the deficiency of protein C [PC] and protein S [PS]. 70 adult patients with documented diagnosis of deep vein thrombosis [DVT] by Doppler ultrasonography were chosen from those were attending the emergency unit of Alexandria main university hospital and Alexandria armed forces hospital in addition to 30 age and sex matched healthy controls were evaluated for PCG test in relation to gold standard tests i.e. PC activity, PS activity and activated protein C resistance [APCR]. Also determination of lupus anticoagulants [LA] was done for all subjects under study. The sensitivity and specificity of PCG test were [100% and 100%] for FV leiden, [87.5% and 82.3%] for PC and [80% and 78.5%] for PS. The negative predictive value was [100%, 98.1% and 98.1%] for FV leiden, PC and PS respectively. The positive predictive value was [100%, 38.9% and 22.2%] for FV leiden, PC and PS respectively. Also, the diagnostic accuracy was [100%, 82.9% and 78.6%] for FV leiden, PC and PS respectively. The results of LA were negative in all patients and controls. However, the normalized ratio [NR] of PCG test was decreased in [14.8%] of patients group without any detectable defect in PC system and their results were significantly lower than control group [P=0.000]. On the other side, the results were considerably higher than those for the patients with a proven defect in PC system. Pro C Global test is sensitive, specific, less time consuming and can be performed on a routine base. Because of the high negative predictive value, we recommend the use of Pro C Global test in the screening of thrombophilic patients and further determination of F V leiden, PC activity and PS activity is only indicated in case of abnormal Pro C Global results