Clinical significance of LncRNA-MIAT as a non-invasive diagnostic marker of nonHodgkin's lymphoma associated with occult hepatitis C virus infection

Aims: the current research aimed to investigate LncRNA-MIAT in patients with nonHodgkin lymphoma (NHL) and to assess its correlation with clinicopathological features and treatment protocols of NHLs among Egyptian patients with Occult hepatitis C virus (HCV) infection (OCI). Patients & Methods: This study was conducted on 20 patients with NHL and 30 healthy subjects as the control group. All subjects were screened for HCV-RNA in both plasma and PBMCs. RT-PCR determined lncRNA-MIAT. Results: lncRNA-MIAT relative expression level was upregulated in NHL groups (2.73±0.86) compared to controls (1.06±0.07), P ˂0.001*. Among NHL, patients with OCI (3.2±0.63) had significantly higher levels of lncRNA-MIAT compared to HCV (2.6±1.08) and non-HCV (2.4±0.4), P ˂0.001*. Additionally, the relative expression levels of lncRNA-MIAT were significantly positively correlated with laboratory and clinicopathological features of NHL. Interestingly, concerning the treatment of DLBCLNHL, there were significantly higher levels of lncRNA-MIAT in no treatment subgroup (n=10, 3.31±0.95) compared to successfully treated subgroups [CHOP (n=7, 1.58±0.34) and R-CHOP (n=3, 11.16±0.21), P ˂0.001* Conclusions: lncRNA-MIAT level was upregulated in NHL patients, particularly patients with OCI. Thus, circulatory lncRNA-MIAT may serve as a promising non-invasive diagnostic marker for NHL associated with OCI

The gamma-glutamyl transpeptidase to platelet ratio (GPR) and the gammaglutamyl transpeptidase to albumin (GAR) versus fibroscan as indicators of hepatic fibrosis in Non-Alcoholic Fatty Liver Disease Patients

Background: Identifying patients at risk with Non-alcoholic fatty liver disease (NAFLD) related fibrosis is crucial. Many noninvasive fibrosis markers were developed recently in chronic hepatitis C and B patients, but a few were evaluated in NAFLD. Aim: to assess the accuracy of the gamma-glutamyl transpeptidase and the other noninvasive markers gamma-glutamyl transpeptidase-to-platelet ratio and gammaglutamyl transpeptidase-to-albumin ratio (GPR and GAR) versus fibroscan as indicators of hepatic fibrosis in NAFLD patients. Patients and Methods: A total of 100 NAFLD patients were examined by abdominal ultrasound and then fibroscan to assess liver steatosis and fibrosis. They were grouped into the early fibrosis group and the advanced fibrosis group. Demographic data and laboratory investigation were collected. GPR and GAR were calculated. The correlation between them and liver stiffness measurement (LSM) was reported. The accuracy of predicting liver fibrosis was assessed. Results: There was a significant positive correlation between GPR and GAR and the degree of fibrosis. GPR (P <0.001*) and GAR (P <0.001*) were independent predictors for advanced hepatic fibrosis by multiple linear regression analysis. Fibrosis score was used as the dependent variable, with the other studied biomarkers as independent variables. The AUCs of GPR and GAR were 0.790 and 0.949 in assessing liver fibrosis, respectively. Conclusion: GPR and GAR were positively correlated with hepatic fibrosis and may be used as a novel, simple, accurate, and low-cost parameter for diagnosing hepatic fibrosis in NAFLD patients.

Risk factors of progression of chronic kidney disease patients under conservative treatment.

Background: Chronic kidney disease (CKD) is recognized as a major health problem affecting approximately 13% of the US population. Early identification and treatment of risk factors of progression of chronic kidney disease can provide marked benefits later in the term of delaying progression to renal replacement therapy. Methods: The medical chart for 92 CKD patients on regular follow up in low clearance clinic with GFR below 20 ml/min were retrospectively reviewed annually for 4 years regular follow up period. The following variables were recorded for each patient: non-modifiable variables (Age, sex, nationality, BMI, systolic and diastolic blood pressure, smoking status, causes of kidney disease, diabetes status, hepatitis status, medication used (like ACEi/ARBs and Sodium bicarbonate) and modifiable variables which includes: Serum albumin, potassium level, serum bicarbonate level, level of proteinuria, rate of GFR decline (Delta GFR) /year, total cholesterol level and hemoglobin level. Then they were divided into 2 groups according to the endpoint during the follow up period. Group 1 include patients did not start dialysis yet and group 2 which include patients who started dialysis during their regular follow up period. Results: There is no statistically significant differences between the two groups regarding Age , sex, systolic and diastolic blood pressure and Body Mass Index( BMI), serum albumin and haemoglobin levels (p 0.295, 0.317, 0.220, 0.181,0.805, 0.884 and 0.451 respectively). There is no statistically a difference between the two groups regarding serum potassium level and serum total cholesterol level (p 0.515 and 0.517 respectively). Diabetic patients started dialysis earlier than non-diabetics with statistically significant difference between the two groups (p 0.029). The patients who weren’t taking ACEi or ARBs started dialysis earlier than those who were taking (p 0.005), while there was no significant differences between the two groups regarding sodium bicarbonate intake (p 0.256). Low sodium bicarbonate level and severity of proteinuria are of significantly important risk factors for progression of CKD disease (p 0.006 and 0.029 respectively). Conclusions: The most important risk factors for rapid progression are presence of diabetes, severity of proteinuria and low serum bicarbonate level in advanced stages of chronic kidney disease. Early recognition of these risk factors and their correction may retard the progression of CKD, which will delay the need for renal replacement therapy. In addition, ACEI or ARBs intake are almost renoprotective and may delay the rapid progression of chronic kidney disease especially in proteinuric patients.

Evaluation of hepatitis B vaccine responsiveness in hemodialysis and peritoneal dialysis patients.

Background: Hepatitis B Virus (HBV) infection is considered as a major cause of liver cirrhosis and hepatocellular carcinoma. Patients with End Stage Renal Disease (ESRD) are a risk group for HBV infection. The vaccine of hepatitis B has been recommended for prevention of HBV infection in ESRD patient especially on renal replacement therapy. Methods: Eighty seven patients with ESRD on peritoneal dialysis and hemodialysis requiring primary hepatitis B vaccination were enrolled in the study. Each of them received 40 μg of recombinant hepatitis B vaccine in a four-dose schedule. Antibody response was determined by the levels of antibodies to the hepatitis B surface antigen (anti-HBs) after last doses of the vaccination schedule. Results: We observed three response patterns to the immunizations in all patients after vaccination, the nonresponders (24.7%) never reached the minimum protective titer of 10 mIU/mL, the poor responders (18.5%) had titers between 10 and 100 mIU/mL, and the good responders (56.8%) had antibody titers above 100 mIU/mL. Despite a reduction in anti-HBs over time, the good responders did not become unprotected during the observation period, especially those participants who had titers above 1000 mIU/mL after the initial immunization. Conclusions: We concluded that the immune response of the HBV vaccine was reduced in the HD and PD patients, which need yearly re-evaluation of seroconversion with booster doses of HBV vaccination if needed.