Ultrasonographic findings of gall bladder in acute viral hepatitis

Thirty patients with acute viral hepatitis were studied for ultrasonographic findings of the gall bladder [GB] and for detection of patients with cholecystitis-like presentations within the first week of diagnosis. Patients were subjected to full history taking, clinical examination, laboratory and serological investigations, in addition to real time abdominal ultrasonography. Serologically, patients were classified into 3 groups: hepatitis-A virus [HAV] group; 16 patients [53%], hepatitis-B virus [HBV] group; 8 patients [27%], and hepatitis-C virus [HCV] group; 6 patients [20%]. The commonest ultrasonographic finding was increased GB wall thickness [GBWT], in 23 / 30 patients [76.7%]. It was more evident in patients with HAV. Twenty out of 23 patients [86.9%] with GBWT,exhibited clinical presentation similar to that of acute noncalcular cholecystitis, the so called; cholecystitis-like presentations. It was concluded that; GB wall thickening with cholecystitis - like presentations seemed to be more common in patients with acute viral hepatitis, particularly; HAV infection. Acute viral hepatitis must be considered as an underlying cause in patients with ultrasonographic diagnosis of acute non-calcular cholecystitis. Ultrasonography follow-up of GB changes associated with acute viral hepatitis is recommended

Plasma markers of thrombin generation, fibrinolysis and activated platelets in sickle cell disease

Thrombotic phenomenon has an important role in the vasooclusive manifestations of sickle cell disease [SCD] that dominate its clinical spectrum. For evaluation of thrombotic activities in SCD patients, the markers of thrombin generation: thrombin anti-thrombin complex [TAT] and prothrombin fragment 1, 2 [F 1, 2], enhanced fibrinolysis markers: plasmin anti- plasmin complex [PAP] and D-dimer and platelet activation markers: platelet factor 4 [PF4] and B - thromboglobulin [BTG] were measured in 35 patients with SCD [25 during steady state and 10 during crisis], compared to 12 normal controls. The measurements were performed by enzyme-linked immunosorbent assays. The thrombotic markers [TAT and F 1, 2], fibrinolytic markers [PAP and D-dimer] and platelet activation markers [PF4 and BTG] were significantly increased in SCD patients during steady state. During vasooclusive crisis, there were marked increase in TAT, D- dimer, BTG and PF4 while there was no significant increase in the levels of PAP and F 1, 2. Also, there was significantly positive correlation among thrombin generation markers, platelet activation markers and fibrinolysis markers in SCD patients during steady state. During episodes there was significant positive correlation among markers of thrombin generation, fibrinolysis and platelet activation except PAP and F 1, 2 markers as compared with asymptomatic intervals. We concluded that, during pain episodes, there was enhanced platelet procoagulant activity, elevated fibrinolytic activity and thrombin generation. These changes may predict the frequency of pain. These findings suggested that increased their levels may increase the risk of thrombosis in these patients and establish a relationship between the laboratory determination of these parameters and clinical pain episodes in patients with SCD. The findings of platelet activation, fibrinolytic activity and thrombin generation in asymptomatic patients indicate ongoing subclinical thrombogeinc activity in patients with SCD

Pattern of pathogens in acute diarrhea in children

Most cases of diarrhea in children occur due to infectious agents that are transmitted faeco-orally. Diarrhea may follow bacterial, viral, protozoal infections of the intestine, and also biochemical. To study the main enterpathogens causing diarrhea, the faeces of 150 children less than 6 years old from both sexes were analyzed. Microbiological analysis was carried out on these samples to identify which intestinal pathogens were present. Of the samples studied 129 cases [86%] were pathogen positive. Co-infection with more than one agent was detected in 44 cases [29.3%] of all patients. The most common pathogen isolated was E.coli detected in 78 cases [52%] with predominance of serotype O119 isolates [44.4%], followed by O111 [26.6%]. The second frequent one is rotavirus, it was detected in 39 cases [26%]. Other pathogens that were detected include: Shigella 9: cases [6%], Salmonella one case [0.66%], Campylobacter sp. 9 cases [6%], Cryptosporidium sp. 4 cases [2%], Giardia lamblia 17 cases [11.3%]. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied. We concluded that bacteria were the most frequent pathogens detected in acute diarrhea, among which E. coli was highly predominant and the majority of E.coli strains belong to EPEC varieties. Rotavirus was found in a great number of diarrheal cases, often associated with bacteria, efforts to prevent transmission of E.coli. and rotavirus to young children should be a public health priority. We suggest the introduction of rotavirus diagnostic tests in microbiological examination of diarrheic stool of children below 6 years of children. Protozoa showed reduced importance

expression of liver hepatocyte growth factor receptors [HGFR] in patients with chronic viral hepatitis: clinical, biochemical and pathological significances

The hepatocyte growth factor receptors [HGFR] are transmembrane proteins that mediate the mitogenic effect of hepatocyte growth factor [HGF] on liver cells. In this study, the expression of liver HGF receptors was assessed in sixty patients with chronic viral hepatitis in order to explore the clinical and pathological significances of their detection in such disease. Liver HGFR expression was demonstrated in 40% of patients and was found in parallel relationship to the degree of hepatic inflammation and necrosis and in negative correlation with the value of prothrombin time. It is concluded that in patients with chronic viral hepatitis the expression of liver HGFR tend to be higher in patients with chronic active hepatitis than in patients with hepatic cirrhosis and may promote better synthetic function of liver cells