Serum Fetuin A, hs-CRP and Homocysteine as Biochemical Markers of Cardiovascular Complications in Chronic Dialysis Patients.

Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcifi cation plays central role. A pivotal role in the inhibition of calcifi cation is played by fetuin-A. Th e measurement of infl ammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: Th e study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a signifi cant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a signifi cant increase in hs-CRP, homocysteine and only those with CVD had signifi cantly decreased fetuin-A in relation to CKD patients. Th e study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: Th e combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be eff ective for discrimination of CVD patients from other ESRD or CKD patients.

Evaluation of serum glypican-3 and a-fetoprotein levels in patients with liver cirrhosis and hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common malignant tumors. HCC occurs mainly in patients with chronic liver disease such as in hepatitis B and C infection. HCC lesion of one cm in diameter with high or low echogenicity can be detected by ultrasonography and confirmed by liver needle biopsy, however, it is still very difficult to detect small isoechogenic HCC lesions especially when a-fetoprotein [AFP] is normal. The serum level of Glypican-3 [GPC-3] has been reported as a marker of HCC. The aim of our study was to evaluate the diagnostic value of serum [GPC-3] and a-AFP in patients with liver cirrhosis and HCC. All patients were subjected to full history taking, clinical examination, laboratory investigations, abdominal ultrasonography and ultrasonography guided percutaneous liver needle biopsy. To evaluate the role of [GPC-3] in the diagnosis of HCC, we simultaneously studied serum [GPC-3] and [AFP] levels in 40 patients with cirrhosis, 40 patients with HCC and 40 healthy subjects as a control. Serum [GPC-3] in patients with HCC [563 +/- 220ng/ml] and in cirrhotic patients [275 +/- 153 ng/ml] was significantly higher than control [206 +/- 127 mg/ml p<0.001] with 300 ng/ml [mean value of controls plus 2 standard deviations] considered as the cut-off point. [GPC-3] was more sensitive [86 vs 65%] but less specific [80.5 vs 90.9%] than [AFP] at level of > 400 ng/ml as a tumour marker of HCC. We conclude that [GPC-3] is useful marker, in conjunction with [AFP] and liver ultrasonography for detecting HCC

Gamma-glutamyl transpeptidase and alpha-fetoprotein: are they predictors of treatment response in patients with chronic hepatitis C?

Hepatitis C virus is a leading cause of chronic liver disease. Elevated serum alpha-fetoprotein [AFP] has been used as a marker for hepatic regeneration after the destruction of hepatocyte in viral hepatitis. Recently, gamma-glutamyl transpeptidase [GGT] has also been taken into account in the evaluation of patients with chronic hepatitis C [CHC]. This study aimed to examine the association between serum AFP and serum GGT levels, and treatment outcome in patients with CHC treated with pegylated interferon and ribavirin. We examined the association between AFP and GGT levels and sustained virological response [SVR] in 150 patients with CHC in whom antiviral therapy was initiated. Serum AFP, GGT, and hepatitis C virus RNA were tested for patients completing 48 weeks of treatment and patients who responded to treatment after 6 months. AFP and GGT levels were lesser in patients who achieved SVR than in those who did not achieve a response. The logistic regression model [univariate analysis] of factors associated with SVR showed a significant increase in SVR when AFP ranged from 2.8 to 9.9 micro g/ml, GGT less than or equal to 50 U/l, and Ishak fibrosis score less than or equal to F2. Serum AFP and GGTwere strongly correlated in multivariate analysis; only GGT less than or equal to 50 U/l and AFP from 2.8 to 9.9 micro g/ml were independent predictors of SVR, whereas Ishak score of fibrosis was a dependent predictor for SVR. AFP and GGT can be used as independent predictors of treatment response in patients with CHC receiving pegylated interferon and ribavirin

Evaluation of plasma osteopontin level as a biomarker for hepatocellular carcinoma in Egyptian patients

Hepatocellular carcinoma [HCC] is a major health problem worldwide. Up to 80% of HCCs develop against a background of cirrhosis of the liver, and although we believe that surveillance of the at-risk cirrhotic population could aid earlier detection of the disease and decrease the cancer-related mortality rate, our this success is limited by the lack of sensitive biomarkers. To evaluate plasma osteopontin level as a potential marker of HCC compared with alpha fetoprotein. This study was conducted on 80 patients classified into two groups [HCC group n=40] and chronic liver disease group n=40], in addition to 30 age-matched and sexmatched healthy participants as a control group. HCC was diagnosed histologically or by imaging. Plasma alpha fetoprotein and plasma osteopontin levels were quantitatively determined using enzyme-linked immunosorbent assay kits. Plasma osteopontin level was significantly higher in patients with HCC compared with chronic liver disease and control participants [P<0.01]. Osteopontin at the best cutoff value [325.5 micro g/ml] had sensitivity of 87.5%, specificity of 80%, positive predictive value of 85.3%, and negative predictive value of 82.7% for detection of HCC cases [area under the curve=0.876]. Osteopontin level was not correlated to a fetoprotein level. Comparing osteopontin with a fetoprotein for prediction of patients with HCC, alpha fetoprotein at a cut-off value of 200 micro g/ml failed to predict 21 patients [52.5%], of whom 16 patients [76%] would be diagnosed by elevated osteopontin above 325 micro g/ml [cut-off value]. OPN is clearly a potential diagnostic marker for HCC. Osteopontin level of 325 micro g/ml was proposed as a significant cut-off value for the diagnosis of HCC

Can we use GP73 as a biomarker for the detection of hepatocellular carcinoma?

Hepatocellular carcinoma [HCC] is one of the top five leading causes of death in Egypt and its prevalence is increasing in the next 10-20 years. We aimed to detect the serum Golgi protein 73 [GP73] in patients with cirrhosis and with HCC, and to determine its sensitivity and specificity as a screening tool for the detection of HCC in this study. Serum GP73 was estimated in 93 participants [patients with HCC, patients with cirrhosis, and healthy controls]. GP73 was elevated in patients with HCC and liver cirrhosis; serum level was very high in HCC patients [P<0.01] when compared with the other studied groups. GP73 had sensitivity of 76%, specificity of 75%, at a cut-off value of 16.2 ng/ml with area under the receiver operator characteristic of 0.825 when compared with alpha-fetoprotein that showed a sensitivity of 63%, specificity of 43% at a cut-off value of 16.5 ng/ml and area under the receiver operator characteristic of 0.611. By combining alpha-fetoprotein and GP73 for the diagnosis of HCC, sensitivity and specificity were [93 and 25%], respectively. There is a significant positive correlation between diameter of the focal lesion and GP73 [P=0.01 and r=0.071]. Nonsignificant positive correlation was detected as regards serum GP73 and the number of HCC. GP73 can be used as a screening tool for the detection of HCC. Moreover, it shows a higher serum level with larger lesions

Assessment of interleukin-6 in diagnosis of hepatocellular carcinoma

Interleukin-6 [IL-6] is a promising tumor marker for hepatocellular carcinoma [HCC]. IL-6 may help to identify a subset of HCC patients with low alpha-fetoprotein [AFP] level and may serve as a complementary tumor marker. To assess the value of serum interleukin-6 levels in patients with chronic liver disease and its level in patients with HCC. To evaluate as well its sensitivity and specificity in comparison to AFP in diagnosis of HCC. Seventy five patients with chronic liver disease [the population of the study] were assessed for serum interleukin-6 levels. The patients were allocated into three groups: Group I: Included 25 patients diagnosed as chronic liver disease with no evidence of HCC. Group II: Included 25 patients diagnosed as HCC on top of post-viral hepatitic chronic liver disease with elevation in AFP [>200ng]. Group III: Included 25 patients diagnosed as HCC on top of post-viral hepatitis chronic liver disease without elevation in AFP [200ng]. Control group: Included 25 age- and sex-matched healthy volunteer controls, with no evidence of liver disease and/or of neoplasm. This study revealed a high statistically significant difference between the three studied groups and controls regarding serum IL-6 levels [P<0.01]. There was a statistical significant positive correlation between mean levels of I L-6 and AFP in HCC patients in group II and III [HCC= 50cases] [P< 0.05]. Regarding the Child-Pugh staging of liver disease, the study revealed that the mean levels of IL-6 in Child C was higher than in Child A and B, but without a statistically significant difference. By using multiple logistic regressions, only loss of weight and AFP had a statistical significant association with the diagnosis of HCC in this study [P< 0.05]. The diagnostic value of IL-6 is significantly increased when it is associated with AFP measurement. Combining the two markers provides a new perspective in the diagnosis of HCC. Our data indicate that IL-6 may be a promising marker for assessment of chronic liver disease [according to Child-Pugh Staging System]. Unfortunately, Interleukin-6 is not a candidate novel tumor marker in detecting HCC patients [with serum AFP level below 200ng/ml]

Protective effect of L-carnitine against carbon tetrachloride-induced liver injury in rats

Oxidative damage is involved in the pathogenesis of various, hepatic injuries. In the present study the capacity of L-carnitine as an antioxidant to protect against carbon tetrachloride [CCl[4]]-induced oxidative stress and hepatotoxicity in rats was Cairo. Egypt investigated. Daily oral administration of CCl[4]100 mg/kg in corn oil for 4 weeks produced a marked significant elevation in serum, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], lactate dehydrogenase [LDH], and alpha fetoprotein [AFP]. Hepatic lipid peroxidation, quantified as malondialdehyde [MDA] was significantly increased, while the activity of the two antioxidant enzymes; glutathione peroxidase [GPx] and superoxide dismutase [SOD] in the liver were significantly reduced. Histopathological and histochemical analyses of the liver of rats treated with CCl[4] revealed centrilobular necrosis with lymphocytic infiltration between hepatocytes. The hepatocytes were damaged in the form of fatty degeneration, vacuolization, ballooning with bundles of fibrous tissue surrounding the portal tracts and dissecting the parenchyma. Concurrent administration of L-carnitine [50 mg/kg/day; s.c.] with CC!4 for 4 weeks produced a significant reduction of aminotransferases together with normalization of ALP and LDH activities as well as AFP level. The biochemical parameters of oxidative stress were improved. Hepatic MDA concentration was significantly reduced, while the activities of the hepatic antioxidant enzymes GPx and SOD were significantly increased. These effects were paralleled with an improvement of the histopathological changes induced by CCl[4], where the hepatic architecture was preserved by L-carnitine treatment. Therefore, the results of this study show that L-carnitine can be proposed to protect the liver against CCl[4]-induced oxidative damage in rats, and the hepatoprotective effect might be correlated with its antioxidant and free radical scavenger effects

Epstein barr virus DNA in hepatocelullar carcinoma tissues from hepatitis C positive Egyptian patients

Hepatocellular carcinoma [HCC] is one of the most frequent malignant tumors. It possesses the characteristics of high malignancy, rapid progress and poor prognosis. In recent years, studies have suggested that Epstein-Barr virus [EBV] is associated with HCC although opposite results have been subsequently reported. The present study was to determine the prevalence of EBV in HCC Egyptian patients, and whether EBV acts synergistically with hepatitis viruses in HCC carcinogenesis. The study included 61 patients, 20 HCV positive patients without HCC [16 males and 4 females] and 41 patients with proved HCC. They were subclassified into 3 groups [21 HCV positive [18 males and 3 female], 10 HBV positive [8 males and 2 females] and 10 HCC patients negative for both HCV and HBV [7 males and 3 females]]. Thorough clinical examination, abdominal ultrasonography and liver spiral CT were done. Liver function tests and serum alpha-fetoprotein [AFP], viral hepatitis markers for B and C, anti-EBV early antigen [EA-IgM], virus capsular antigen [VCA-IgMl and HCV RNA by reverse transcription PCR [RT-PCR] were measured. EBV-BamHI W DNA, and EBV-LMP1 DNA were performed by conventional PCR in the tumorus liver tissue of 41 HCC patients and the 20 noncarcinoma patients [HCV without HCC]. The positive ratios were compared between HCC subgroups and non tumorus HCV group. Our results revealed that, EBV-BamHI W DNA and/or EBV-LMP1 DNA were positive in 25 [40.9%] among overall 61 studied cases. In HCC patients, EBV-BamHI W DNA and/or EBV-LMP1 DNA were positive in 13 [61.9%] out of 21 HCV positive, 2 [20%] out of 10 HBV positive cases, 3 [30%] out of 10 cases negative for both HCV and HBV. However, it was positive in 7 [3 5%] out of 20 HCV cases without HCC [non tumotus cases]. The rate of EBV infection in HCC with HCV positive cases was significantly higher [Fisher exact=4.6 1; p<0.05] than HCC with HBV positive ones, HCC cases negative for both B and C virus [Fisher exact-4.28; p<0.05] and chronic HCV [non tumours] cases [Fisher exact=4. 19; p<0.05]. In addition, HCC in EBV DNA positive cases was associated with high HCV viral load, AST, ALT, low serum albumin, while there was no relation to AFP serum levels. In conclusion: the existence of EBV infection in HCC tissues suggests that EBV may be involved in the hepatocellular carcinogenesis in Egypt

Benzene toxicity in shoemakers and role of vitamin A [as antioxidant]

The burden of liver disease in Egypt is exceptionally high. Unquestionably, additional factors contributing to liver disease burden remain to be elucidated. Human exposure to benzene in work environment is a gbbat occupational health problem; it may represent a risk factor for hepatotoxicity, liver cancer and hematotoxicity. The present study aimed to evaluate the hazardous effects of occupational exposure to benzene on liver and blood, as well as the protective role of the antioxidant [vitamin A] on hematotoxic and hepatotoxic effects among shoemakers who exposed to benzene. Twenty hundred and fifty workers were enrolled in this study after taking an informed consent; 140 occupationally exposed workers to benzene for more than 3 years [workers group; subdivided into non-treated and treated with vitamin A], and 110 workers never occupationally exposed to benzene [control group]. The benzene urine level, complete blood counts [CBC5], the liver enzymes, and the tumor marker, alphafetoprotein [AFP] were estimated. The benzene level in urine samples was significantly increased in shoemakers group. Benzene exposed non-treated workers showed significant increase in the liver enzymes and AFP, while the CBCs were significantly lower compared with both control group and benzene exposed treated group with vitamin A. Occupational exposure to benzene found to have hazardous effects, which were reflected on CBCs, liver enzymes, and AFP. Additionally, the vitamin A was observed to be effectively potent in ameliorating the haematotoxic and hepatotoxic effects in exposed workers. Periodic medical care and CBCs in combination with urinary benzene [UB] level were recommended in benzene workers

Evaluation of methods using maternal serum alpha-fetoprotein for antenatal screening of pregnancies for open neural tube defects in east Azerbaijan province of Iran

Neural tube defects, resulting from failure of the neural tube to close during the fourth week of embryogenesis, are the most common severely disabling birth defects in most populations. We assayed alpha fetoprotein [AFP] in serum samples of pregnant women during 15 to 20 weeks of gestation using immuno-enzymatic method [Eliza] in east Azerbaijan/Iran. The results obtained from the first 100 samples were used to calculate the median levels of maternal serum AFP in our ethnic population and the resulted Multiple of Median [MOM] were employed in Prisca software to obtain the likelihood ratio for each pregnancy. Among the 300 pregnancies which were screened for Neural Tube Defects [NTDs], 9 were detected as screen positives. The following targeted ultrasonography revealed fetuses affected by open neural defects in two pregnancies, polyhydraminous with no NTDs in two others and bilateral cleft lip in the one. The screening results were confirmed by clinical examination of the aborted fetuses or newborns. The outcome of the last pregnancy showed bilateral cleft lip + cleft palate and congenital pyloric stenosis at birth. The newborns resulted from two other screen positive pregnancies were normal. No information was obtained from the two remaining pregnancies after the ultra-sound scanning. The median weight of pregnant mothers in sample population was 63.34 +/- 10/66, in screen positive patients 61/11 +/- 11.92 and in screen negative patients 63.30 +/- 10.63. The results obtained from antenatal maternal serum screening in the present study compares favorably with the results from reference centers using similar screening strategies. The method employed in this research is reliable and can be readily applied for screening of a large population of pregnant women for open NTDs

Clinical role of serum squamous cell carcinoma antigen in egyptian patients with hepatocellular carcinoma

Since major advances in our ability to treat hepatocellular carcinoma [HCC] are less likely to come from treating late stage disease it is therefore important to find early stage disease. Serum Alpha-fetoprotein [alpha - FP] is currently the most widely performed screening test, but this sensitivity poor. It has been reported, recently, that squamous cell carcinoma antigen [SCCA] could represent a useful screening marker in patients at risk. The aim of this study to investigate the diagnostic utility of serum SCCA as a non invasive marker in HCC patients compared to alpha-FP. We recruited for the study forty patients with HCC, 25 patients with liver cirrhosis and 15 healthy subjects. Serum levels of SCCA and alpha-FP together with clinical, laboratory, and imaging evaluation were done for all cases. Hepatic focal lesions with atypical CT pattern for HCC were confirmed histopathologically with ultrasound-guided biopsy. Mean values of serum SCCA in HCC group was significantly higher when compared with both the control and cirrhotic groups [p<0.001]. It was significantly elevated in HCC patients showing atypical enhancement pattern versus those with typical one [p<0.05]. At the value of the kit cutoff value [2 ug/l], the specificity and sensitivity of SCCA were 62% and 84% respectively. While when using the receiver operator curve [ROC] curve, to improve the specificity and sensitivity of SCCA, the cutoff value of 2.55 ug/l yielded a sensitivity and specificity of 52.5% and 96% respectively [best cutoff]. The diagnostic sensitivity of alpha-FP at a cutoff 200 ng/dl was 26% and the specificity 100%. The cutoff level of alpha-FP for diagnosis of HCC according to ROC was 91.5 ng/dl yielded a sensitivity and specificity of 62.5% and 92%, respectively [best cutoff]. Simultaneous measurement of alpha-FP and SCCA led to improve the sensitivity of serologic diagnosis of HCC up to 87.5%. SCCA represents a useful diagnostic biomarker for HCC detection, when combined with alpha-FP, it significantly increases the reliability of serologic diagnosis for this cancer. SCCA could specially diagnose those with atypical enhancement pattern in CT scan

Role of vascular endothelial growth factor [VEGF], VEGF/platelets ratio and basic fibroblast growth factor [BFGF] in diagnosis of hepatocellular carcinoma

Pre-therapeutic serum levels of the angiogenic factors VEGF and bFGF were detected in sera of HCC patients, and were compared with the routinely used tumor marker used for diagnosis and follow up of HCC as AFP to evaluate the role of these angiogenic factors in diagnosis of HCC patients. The relation between the serum levels of VEGF, and bFGF and the clinical characteristics of HCC was also elucidated. This study was conducted on 50 patients with hepatocellular carcinoma. Diagnosis was confirmed by fine needle biopsy [FNB]. The study also included 9 patients with hepatitis C, 9 with hepatitis B, and 9 patients with cirrhosis, 11 healthy age and sex matching volunteers were included as controls. HCV patients were diagnosed by positive hepatitis C antibodies. HBV patients were diagnosed by positive hepatitis B surface antigens, while the cirrhotic patients by ultrasonography and positive bilharzial antibodies. All patients and control serum samples were tested for; vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], alpha-fetoprotein [AFP]. Serum VEGF, bFGF and AFP levels were significantly elevated in HCC group. According to tumor size, only AFP showed statistically significant elevation [p 0.048]. bFGF was statistically significantly higher in cases with ascites than in those without ascites [p 0.003]. AFP and bFGF were statistically significantly higher in cases with edema than in those without edema [p 0.03 and 0.05, respectively]. Only AFP showed statistically significant elevation with portal vein thrombosis [p 0.03] and stage of the disease [p 0.002]. On measuring the sensitivity and specificity of the different tumor markers in HCC, VEGF showed the highest sensitivity [98%]. while AFP showed the highest specificity [100%]. The best diagnostic accuracy for double combinations was obtained with [AFP and VEGF], [AFP and VEGF/PLT ratio], [VEGF/PLT ratio and VEGF] and [bFGF and VEGF]. The best triple combination was detected between the combination. [VFGF. bFGF and VEGF/PLT ratio] and with the combination [AFP, bFGF.and VEGF] with diagnostic accuracy of 81.1%, and 80.7% . respectively. Elevated serum VEGF and bFGF levels were encountered n I-ICC compared to control groups. and serum VEGF has a higher sensitivity than other markers for the diagnosis of HCC Combined VEGF with AFP. bFGF. or VEGF/PLT ratio or with bFGF and VEGF/PLT ratio may he used to increase the overall diagnostic accuracy in HCC

Diagnostic value of AFP-L3, AFP-mRNA, and methylated p16 in hepatocellular carcinoma

To assess the diagnostic significance of serum AFP-L3,AFP-mRNA and methylated p16 in patients with liver cirrhosis and HCC. The present study was conducted on patients suffering from liver cirrhosis [n=82] and HCC [n=82]. in addition to healthy control group [n=20]. Cirrhotic patients were followed up every 3 months for 15 months and grouped according to Child classification A, B and C HCC patients were grouped according to Okuda classification I. II. Ill. Blood samples were withdrawn and serum samples were separated for estimation of liver function tests, anti HCV. HBsAg. AFP. and AFP-L3. RNA was extracted from whole blood for detection of AlP mRNA. The buffy coat was collected for DNA extraction for detection of methylated p16. Liver function tests were assayed spectrophotometrically while anti-HCV. HBsAg and AFP were assayed by enzyme immunoassay. AFP-L3 was measured by liquid phase binding assay. AFP-mRNA and metholated P16 were measured by RT-PCR. In the present study. anti-HCV was present in 90.2% of cirrhotic group and 93.4% of HCC group while HBsAg was present in 2.4% of cirrhotic group and 3,fl[of HCC group. There were significant increase in AFP. AFP-L3Y and AFP-L3 concentrations in HCC versus controls and cirrhotic groups. ln cirrhotic group 6 cases are AFP-mRNA positive [two cases of Child A and 4 cases of Child C]. On the other hand all cirrhotic groups were negative of methylated p16. in HCC group 10 cases are positive of mRNA [two cases of Okuda 1.6 cases of Okuda II and 2 cases of Okuda Ill] On the other hand 4 cases of Okuda Ill are positive of methylated p16 and had AFF more than 100 ng/ml. Among 51 patients with liver cirrhosis [followed up by periodic examination with ultrasonography and measurement of serum AFP every 3 months 6 patients developed HCC [11.7%]. The sensitivity of AFP-L3 was 64.1% and a specificity 89.2% or a cutoff level of 1.0% . The sensitivity of AFP was 51.8% and the specificity was 88.2% whereas the sensitivity of AFP-L3 concentration was 51.3% and a specificity 100% for a cutoff level of 22.08 ng/ml. The sensitivity of AFP-mRNA and p16 methylation were 41.6% and 16.6% while the specificity were 75% and 100%, respectively. In HCC group there were significant positive correlations between AFP-L3 concentration and AFP, and AFP-L3% . AFP-L3% had higher sensitivity and specificity than AFP. Thus both markers must be done simultaneously. The detection of methylated p16 had the lowest sensitivity and highest specificity. AFPmRNA and methylated p16 in the blood of HCC patients were significantly correlated with elevated AFP

Pharmaceutical care of patients with hepatocellular carcinoma: could gags be useful as a diagnostic and prognostic tumor marker?

Despite the very high incidence of hepatocellular carcinoma [HCC] in Egypt, surgery is considered as the only curative treatment option. However, most patients are diagnosed at advanced stages thereby surgery will be of little value. The aim of the current study was to provide a pharmaceutical care for patients with HCC who were treated with the investigational drug mistletoe as well as to assess whether glycosaminoglycans [GAGs] could be useful as an effective screening tumor marker for early diagnosis and to investigate the significance of total GAGs serum concentrations in patients with HCC. Blood samples were collected from three groups: the first group [n=50] with HCC, the second with cirrhosis [n=15] and the third was a control [n=15]. Liver and kidney functions laboratory tests and total GAGs concentrations were measured. Only 23% of the patients achieved objective responses to the investigational drug but monitoring of the supportive treatments as well as drug side effects and toxicities were strongly recommended. Patients with HCC showed a significant increase in serum GAGs as compared with the control group [p<0.01]. However, there were no significant differences between cirrhotic group with HCC group or with control group. A significant positive correlation between serum level of GAGs and tumor size [r=0.39, p<0.005] was observed, however there are no correlations between serum concentration of GAGs with other patients or with tumor characteristics. No significant relationship was found between serum level of GAGs and overall survival. We could conclude that pharmaceutical care is very important in patients with HCC to improve their quality of life and serum level of GAGs may have a role in HCC, and their serum level may be related to a high tumor burden

Serum des - gamma - carboxy [abnormal] prothrombin as a marker for hepatocellular carcinoma in Egyptian patients in comparison with alpha-fetoprotein using receiver operation characteristic analysis

To evaluate Des-gamma-carboxy prothrombin [DCP] level as an early detection of hepatocellular carcinoma in Egyptian patients in camparison with alphafetoprotein. Serum DCP and Alpha-fetoprotein [AFP] levels were measured in 132 cases of chronic liver diseases including 40 patients with liver cirrhosis; 32 patients with chronic hepatitis and 60 patients with hepatocellular carcinoma [HCC]. DCP levels were significantly higher in patients with HCC than those with chronic hepatitis [p<0.001] and cirrhosis [p<0.001], no significant difference was found between patients with cirrhosis or with chronic hepatitis and controls. In patients with hepatocellular carcinoma, DCP was correlated with the size of the tumor and the histopathologic grades but not to the Child Pugh grades and most of the liver function tests. Using the receiver operative characteristic [ROC], the cut-off value for the DCP and AFP were set as 40 mAU/ml and 100 ng/ml, respectively, that differentiate patients with HCC from those with cirrhosis. At this level, the sensitivity, the specificity, and diagnostic accuracy of DCP were 78.3%, 86.0% and 83.4; respectively. The sensitivity, specificity, and diagnostic accuracy of AFP were 56.7%, 96% and 70.0% ; respectively. The simultaneous determination of AFP and DCP raised the sensitivity of the test to 84% with specificity of 100% and diagnostic accuracy of 90% . The area under the ROC curves revealed that DCP had a better accuracy than AFP in diagnosis of HCC [0.85 [95% Cl 0.78-0.91 lVs 0.73 [95% Cl, 0.65-0.81], [p=0.013]. Both AFP and DCP are good markers for HCC and their simultaneous determination may improve the detection of HCC in cirrhotic patients negative for AFP

Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A: at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely: miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication

Marcadores séricos en tumores digestivos: ¿más es mejor o sólo más caro? / Serum markers in digestive tumors: is more better or only more expansive?

En la práctica clínica, tendemos a solicitar los marcadores tumorales séricos en forma arbitraria, sin contemplar las normas disponibles o la evidencia bibliográfica. Por esta razón nos planteamos analizar el valor de dichos marcadores en tumores disgestivos, en distintas situaciones clínicas. Cáncer colorrectal: CEA: no resulta de utilidad en el screening, ni para establecer diagnóstico diferencial; es de utilidad: como factor pronóstico independiente del estadío, para predecir recaída junto a otro hallazgo clínico y para monitoreo de respuesta al tratamiento. CA 19-9 sería sólo de utilidad en el monitoreo de respuesta a la quimioterapia, en caso de CEA normal. Adenocarcinoma de páncreas: CA 19-9: Es de utilidad complementaria en el diagnóstico y de dudosa utilidad como factor pronóstico y en el monitoreo de la respuesta. Cáncer del árbol biliar: CA 19-9: Es de utilidad en el diagnóstico (particularmente colangiocarcinoma), como factor pronóstico, en el monitoreo de respuesta al tratamiento y en la detección de recurrencias. El uso combinado de CEA + CA 19-9 resulta mayor especificidad para el diagnóstico de esta enfermedad. Hepatocarcinoma: Alfafetoproteína: Es de utilidad en el screening de población de riesgo y de variable utilidad para el diagnóstico