Raised plasma homocysteine as a risk factor for idiopathic and recurrent deep-vein thrombosis

Previous studies have suggested that hyperhomocysteinemia [Hyper-Hcy] may be a risk factor for venous thrombosis. To assess the risk of venous thrombosis-associated with Hyper-Hcy, we studied plasma total homocysteine [tHcy] levels in patients with deep venous thrombosis and in normal control subjects. Fasting tHcy levels were measured in 40 consecutive patients with objectively diagnosed deep venous thrombosis and in 20 healthy controls matched to the patients according to age and sex. Hyper-Hcy was defined as plasma total homocysteine level > 15 micro mol/l. Plasma homocysteine level was significantly higher in patients than in controls. It was significantly higher in patients with idiopathic [unprovoked] vein thrombosis than in patients with secondary disease [associated with at least one predisposing factor]. Mean homocysteing was higher in male than in female patients and increased with age. Hyperhomocysteinemia was more frequent in patients with relapsing disease than in those presenting with a single episode. Mean homoqsteine level was similar in patients presenting with either proximal or calf vein thrombosis. Mild Hyper-Hcy is an independent risk factor for deep- vein thrombosis, more prevalent in patients with idiopathic or recurrent disease. The next question to be answered is whether homocysteine-lowering therapy - folic acid, vitamin 36 or vitamin B12 contributes to the prevention of recurrent venous thrombosis

Value and limitations of polymerase chain reaction and diffrent serological markers in diagnosis of single and mixed acute viral hepatitis

Introduction: Hepatitis viruses are endemic in Egypt, Many studies were performed in order to study the pattern of acute viral hepatitis [AVH] and all of them were hospital-based. The frequency of viral agents causing hepatitis in the previous studies were conflecting. Aim: to evaluate the value and limitations of polymerase chain reaction [PCR] and different seromarkers in diagnosis of single and mixed AVH. Patients: This study was performed in Sallam village near Assiut city. Active surveillance was performed on 1400 cases using house to house survey and frequent visit to rural health unit. 105 patients with AVH 60 males and 45 females with age ranged from 2 months to 65 years were included in the study. All patients had full history, general and abdominal examination including ultrasound, liver funtion test and different seromarkers. Anti hepatitis A virus [anti-HAV] IgM and IgG, HBs Ag, anti HBc IgM anti HEV IgM and IgG and dithiothreitol [DTT] anti-HCV IgM, cytomegalovirus [CMV] and Epstein Barr virus [EBV] IgM antibodies. Reverse transcriptase polymerase chain reaction RT-PCR] were performed for HCV and HEV. HA V was the most frequent cause of AVH 34 [32.4%], followed by AVE 29 [27.6%], AHB in 9 [8.6%]. Acute hepatitis C [AHC] was diagnosed only in 3 cases [2.9%] one single and two mixed with E virus. Hepatitis C RWA may be suppressed in mixed viral infection as it occurred in two of our cases who had mixed C/E viruses. Two cases were diagnosed CMV and one case mixed CMV/EB V. 70 [66.7%,] had single viral infection, while 14 [13.3%] had mixed viral infection and 16 [15.2%] were negative for all viral markers and diagnosed as non A-E hepatitis. 19 cases had clinical and laboratory evidence of AVH however they had positive anti-HCV Ab six months prior to inclusion, so they were diagnosed as chronic HC. 6 cases were excluded from the study and diagnosed as drug and toxin induced hepatitis. PCR aid variant seromarkers have an important role in diagnosis of AVH, however they have many limitations particularly in acute hepatitis C and mixed infection

Endothelial dysfunction an doxidative stress in gestational diabetes [a follow-up study]

Gestational diabetes is characterized by glucose intolerance first recognized during pregnancy. Women with gestational diabetes are more prone to develop type II diabetes later in life. The increased risk of premature endothelial dysfunction with hyperglycemia might be related in part to augmented expression of cell adhesion molecules. Diabetes is also characterized by oxidative stress which in turn determines endothelial dysfunction via nitric oxide synthase linked pathway. Aim: To evaluate the effect of gestational diabetes on the adhesive molecules and status of oxidative stress. Subjects and Five hundred and eighty seven pregnant women [24-28 weeks of gestation] with no risk factors and normal renal and liver functions were tested for serum glucose by screen test and-when necessary- glucose tolerance curve. Thirty three cases [5.6%] who have gestational diabetes constituted the patients group. Twenty healthy pregnant women with negative screen test and glucose tolerance curve were taken as a control group. Both patients and controls were investigated for serum E- selectin, VCAM-1, endothelin-1, nitric oxide, lipid peroxidation and superoxide dismutase [SOD], during gestation and after delivery. During gestation, sE-selectin was higher and sVCAM-1 was lower in diabetic cases than controls but with no significant differences, while significant elevations of lipid peroxidation [p < 0.01] and SOD [p < 0.001] in patients group compared to control group. Three months after delivery, significant elevations of sE-selectin [p < 0.001], sVCAM-1 [p < 0.001], and SOD [p < 0.001] were observed in women with gestational diabetes compared to the controls. There were significant reduction in lipid peroxidation and SOD [p < 0.001] in the patients after delivery as compared to that during pregnancy, while sE-selectin, sVCAM-1 and NO were higher after delivery than during pregnancy but the difference was statistically insignificant. The controls showed significant decrease in levels of endothelin-1, sE-selectin and sVCAM-l with longitudinal follow up. The follow up study revealed that six cases [patients group A] continued with impaired glucose toerance curve [31.6%] and thirteen cases [patients group B] returned with normal glucose curve. In group A, there were significant elevation of E-selectin [p < 0.05] and significant decrease of endothelin-l [p < 0.01] as compared to group B, while NO and SOD were reduced but the difference was statistically insignificant. Sustained elevations of sE-selectin and sVCAM-1 in cases with gestational diabetes even after delivery may reflect vascular injury or risk factor for endothelial dysfunction. Furthermore the elevations of lipid peroxidation and SOD in the patients group during pregnancy may be implicated this pathogenesis of gestational diabetes and may be considered as sensitive indicators of oxidative stress in gestational diabetes

Anticardiolipin, autoantibodies, and cryoglobulin in patients with chronic hepatitis C and their relation to thrombocytopenia

Introduction: Chronic infection with hepatitis C virus [HCV] has been found to be associated with autoimmune phenomena and extra hepatic manifestations. HCV was implicated as a cause of the development of anti-phospholipid antibodies, leading to the suggestion that this virus may be involved in the aetiopathogenesis of the anti- phospholipid syndrome [APLS]. Aim: to study the association between anticardiolipin, autoantibodies and cryoglobulin with chronic hepatitis C infection and their relation to thrombocytopenia. Patients: Thirty three patients with chronic liver diseases of different stages were included in this study. Twenty seven of them were due to hepatitis C virus [HCV] and 6 were due to hepatitis B virus [HBV]. Their age ranged from 35 to 52 years. Twenty healthy subjects were included as controls In addition to clinical and ultrasonografic examination complete blood count, anticardiolipin [aCL] [IgG and 1gM isolypes], antinuclear antibody [ANA], antismooth muscle antibody [ASMA] antimitochondrial antibody [AMA] and cryoglobulin were done for both patient and control groups. The frequency of aCL antibodies of IgG and IgM isotypes were significantly more in patients with chronic HC infection [59.2% and 81.5 respectively] than that in controls [5% for each] [P < 0.001]. There was no significant relations between the presence of aCL antibodies and the presence of thrombocytopenia. There was no significant difference in the frequency of aCL between patients with chronic HC and chronic HB infection. The frequency of cryoglobidins was more in HC positive patients [63%] than HB positive patients [50%], but the difference was not significant. However ANA and AMA were significantly more in patients with chronic HC group than patients with chronic HB group [P < 0.05] for each. A significant proportion of HCV patients had detectable aCL However no significant association between aCL antibodies and thrombocytopenia was detected

value of soluble transferrin receptor in early diagnosis of iron deficiency anemia in chronic renal failure

Decreased erythropoietin [EPO] production is the main pathogenic factor of anemia in chronic renal failure [CRF]. Iron deficiency is the most common cause of EPO resistance in dialyzed patients with renal failure. Subclinical or functional iron deficiency is difficult to diagnose in these patients. Aim: This study was designed to determine the sensitivity and specificity of serum iron, transferring, ferritin and soluble serum transferrin receptor [sTFR] in diagnosis of iron deficiency in chronic renal failure and the efficacy of recombinant human EPO [rHuEPO] treatment. Patients: This study was conducted on 70 patients with CRF divided into three groups: group [A] CRF patients predialysis [30 cases], group [B] CRF patients on regular dialysis > 5 years [30 cases], and group [C] CRF patients on dialysis and rHuEPO treatment with parentral iron supplementation [10 cases].Twenty healthy individuals age and sex matched were included as controls. Peripheral hemogram, serum urea and creatinine, serum iron [SI] and total iron binding capacity [TIBC], serum ferritin, serum transferring and [sTFR] were done for both patients and control group. There was highly significant reduction of RBCs, hemoglobin [Hb] and hematocrit [Hct] in different patients groups compared to controls; [P < 0.001] for each Serum iron [SI] was insignificantly reduced in groups A and B compared to controls while it was significantly increased in group C [P < 0.05]. Serw transferrin was significantly reduced in all patients groups compared to controls [P < 0.001] for each. Serum ferritin and sTFR were significantly increased in both group, A and B [P < 0.001] for each, while in group C, there was significant increase in serum ferritin [P < 0.01] and no significant difference in sTFR level compared to controls. sTFR is a sensitive [sensitivity 93%] and specific [specificity 100%] indicator for identifying iron deficiency and assessing the effect of rHuEPO treatment in CRF patients

Serum levels of adhesion molecules in lichen planus and the effect of associated hepatitis C virus

The aim of this work was to measure the serum levels of intercellular adhesion molecule [ICAM-1], vascular adhesion molecule [VCAM-1] and E- selectin in lichen planus [LP] patients and to compare the levels of these adhesion molecules in LP patients associated with and without hepatitis C virus [HCV]. The serum levels of sICAM-1, sVCAM-1 and sE- selectin were measured by ELISA in 48 LP patients [38 classic and 10 actinic] and 24 healthy controls. Both patients and controls were screened for hepatitis C virus antibodies by ELISA technique. The serum levels of sICAM-1, sVCAM-1 and sE-selectin were significantly higher in LP patients compared with the controls. Only sE-selectin was significantly higher in actinic patients compared with patients with classical LP. There was no significant difference in the studied parameters between patients with and without mucus membrane affection. Hepatitis C associated LP patients had significantly higher levels of sICAM-1 and sVCAM-1 compared with hepatitis C negative patients. No significant difference in the levels of sE-selectin was found between the two groups

role of tumor necrosis factor alpha and its soluble receptors in infection complicating acute leukemia

This study aimed to examine the changes that occur in the levels of tumor necrosis factor [TNF-alpha] and its soluble receptors in infection in patients with acute myeloid leukemia [AML] and the changes that occur in these parameters during the neutropenic state. Forty-seven patients of newly diagnosed AML [with age range 12-60 years] as well as 25 age and sex matched healthy subjects were included in this study. The patients group was subdivided into four subgroups according to the presence or absence of fever and neutropenia. It was concluded that the levels of soluble receptors of TNF-alpha in the serum may reflect the inflammatory status better than TNF-alpha levels and the rise in their levels is correlated with the severity of sepsis