Relation of hypoalbuminemia and liver cirrhosis to plasma tumour necrosis factor-alpha and interferon gamma among chronic active hepatitis C patients in Damanhour Medical National Institute

Tumour necrosis factor alpha [TNF-alpha] and interferon gamma [INF-gamma] are cytokines involved in natural immune responses and are important in antiviral modulation. INF-gamma is an immunostimulatory or growth-promoting factor that activates the macrophages and natural killer [NK] cells, while plasma TNF- alpha is a proinflammatory cytokine that participates with interleukine -1 [IL-1] and interleukine - 6 [IL-6] in the acute phase response and synergizes to mediate inflammation, shock and death. The World Health Organization has now recognized hepatitis C virus [HCV] as a major public health problem. The present study was conducted to assess the level of endogenous interferon [IFN-gamma] and tumor necrosis factor [TNF- alpha] to evaluate the immunological changes occurring among patients with HCV, and to study the relation of hypoalbuminemia and liver cirrhosis to plasma TNF-alpha and INF-gamma, in order to implement a nutritional care program appropriate for every patient according to his health status. The study was conducted on 2 groups of individuals. Group I comprised 40 patients infected with HCV, not treated with any antiviral medication, while group 2 comprised 20 healthy individuals who served as controls. Both groups were subjected to clinical examination, assessment of nutritional status and laboratory investigations including complete blood picture [CBC], liver function tests, plasma TNF- alpha, and IFN-gamma estimation. A significant increase in serum alanine transferase [s. ALT], Gamma giutamyl transferase [s. GGT], serum bilirubin [s. bil.], plasma INF -gamma and plasma TNF- alpha at P= 0.00. Meanwhile the levels of prothrombin activity, platelet count and s. albumin [s. aib] demonstrate a significant reduction at P= 0.00 when cirrhotic and non-cirrhotic HCV patients with or without hypoalbuminemia wee compared to controls. An inverse significant correlation was found between s. bilirubin level and plasma INF -gamma among cirrhotic patients, and between s. bilirubin level and plasma TN F- alpha, but a positive association between plasma TNF- alpha and s. alb and WBC count was found among patients with hypoaibuminemia. However, no significant correlation was detected between serum albumin and plasma TNF- alpha and plasma INF -gamma among cirrhotic or non-cirrhotic patients at P<0.00. Hypoalbuminemia and liver cirrhosis could probably affect the antiviral modular activity of plasma TNF- alpha and endogenous IFN-gamma among HCV patients

Quiantification and characterization of protein loss in continuous ambulatory peritoneal dialysis / Cuantificación y caracterización de las pérdidas proteicas en diálisis peritoneal continua ambulatoria

Antecedentes/Objetivos. La pérdida de proteínas en el dializado ha sido involucrado en la etiología de la hipoalbuminemia y/o desnutrición en DPCA. No hay información acerca del transporte peritoneal de proteínas en pacientes en DPCA en México ni en Latinoamérica. Por lo tanto, el objetivo de este estudio fue cuantificar y caracterizar el transporte peritoneal de albúmina (Alb), IgG, IgA, e IgM en pacientes en DPCA. Además, algunos factores asociados a las pérdidas proteicas fueron investigados. Métodos. Treinta y siete pacientes en DPCA fueron seleccionados al azar y sometidos a una prueba de equilibrio peritoneal (PEP). Durante dicha PEP, se midieron las concentraciones de Alb, IgG, IgA, e IgM en el suero y el dializado. Resultados. La IgM no se detectó en el dializado por el método nefelométrico usado. Un claro patrón de incremento continuo y gradual en las pérdidas peritoneales de Alb, IgG e IgA se observó durante toda la PEP. Durante la PEP, los pacientes con los tipos de transporte peritoneal más rápidos tuvieron las concentraciones más bajas de Alb (pero no de inmunoglobulinas) y las pérdidas dialíticas más grandes de todas las proteínas evaluadas. El factor predictor más importante de las pérdidas de Alb, IgG, e IgA fue la tasa de transporte peritoneal, tanto en el análisis univariado como en el multivariado. Conclusiones. Las pérdidas peritoneales de Alb, IgG, e IgA en pacientes mexicanos en DPCA son principalmente dependientes de la tasa de transporte peritoneal y del tiempo de permanencia de la solución de diálisis en la cavidad peritoneal.