Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Background: Spontaneous bacterial peritonitis [SBP] is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients: however, there is a lack of knowledge about this issue in ascitic infections

Aim of the study: The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous bacterial peritonitis which may help to understand the role of immune system in pathogenesis of SBP and consequently introduction of new therapeutic modalities

Subjects and methods: This case-control study included 50 decompensated cirrhotic patients [37 male. 13 female] from gastroenterology and hepatology unit of internal medicine department; Assiut university hospital with different etiologies. Patients with ascitic polymorphonuclear leukocyte count >/=250/mm[3] and/or positive ascitic bacterial cultures were classified as the 'patients group' [n=25, mean +/- SD of age was 57.84 +/- 6.66 years]. Patients with ascitic poly morphonuclear leukocyte count <250/mm[3] and/or negative ascitic bacterial cultures were classified as the controls group [n=25, mean +/- SD of age was 60.36 +/- 6.51years]. Comparison was made between the patients and controls groups for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of ascitic lymphocyte subsets [CD3, CD4. CD8, CD4/CD8 ratio. CD19, CD45] and ascitic cytokine TNF-alpha

Results: Ascitic total protein and albumin levels were significantly decreased in patients group. The C4, CD19. CD45 and CD4/CD8 ratio were significantly decreased in the patients group. Furthermore, ascites CD3, CD8 and TNF-alpha levels were significantly elevated in this group. The incidence of renal impairment, gastrointestinal bleeding and hepatic encephalopathy was higher in patients group and there was a significant correlation between TNF-alpha and renal impairment in this group

Conclusion: These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might he involved in the pathogenesis of ascites infections

Hepatitis B virus escape mutants after vaccination

Vaccine escape mutant may develop after immune prophylaxis with universal HBV vaccination. Aim of the study: to detect the frequency of HBsAg escape mutant among the patients with previous HBV infection and patients with HCV infection after full dose of HBV vaccination. A hospital control based study included 68 person. Twenty six with previous HBV infection patients, 25 chronic hepatitis C patients, and 17 apparently healthy persons as controls. Vaccination were carried out for all patients and control group. All patients and control groups were negative for HBs Ag before enrollment in this study. HBsAg, HbcAb, HBeAg and HBsAb were enrollment performed by micro particle immunoassay. HBV DNA and HBsAg mutants were performed by real time polymerase reaction [RT-PCR]. HBV DNA was detected in 10[38.5%] in HBV patients with previous infection and after full dose of vaccination. HBsAg mutants were detected in 8[30.8%] of them. In HCV patients with negative surface antigenemia HBV DNA was detected in 5 [20%] and HBsAg mutants were detected in 3[12%] of them. The frequency and levels of HBsAb in HBV patients with previous infection and after full dose of vaccination were significantly decreased when compared to those with HCV infection and healthy control group after dose of vaccination. From this study we concluded that the presence of HBsAg mutants in HBV and HCV patients with negative surface antigenemia after full dose vaccination .the measurement of HBV DNA by sensitive quantitative technique plays an important role in detection either with mutants in surface antigen or occult HBV infection [OBI]. Lower immune response was markedly observed after prophylactic vaccination of patients with previous HBV infection with and to lesser extent in those with HCV infection. HBcAb and or HBV DNA testing should be considered before HBV vaccination to avoid the vaccine induced pressure which may lead to development of HBV surface antigen mutations

Gastric endosonography in non hodgkin lymphoma

Endoscopic ultrasound [EUS] examinations are necessary to determine the intramural and gastric lesions. The aim of the present study was to evaluate the role of EUS in detection of lesions in patients with Non Hodgkin Lymphoma [NHL], whether the patients have gastric or not. We evaluated gastric lesions in 2 groups of NHL, ten patients with gastric [group A] and 10 patients without gastric symptoms [Group B]. EUS was performed with 7.5 frequency oblique probe. EUS showed normal wail layers with multiple paragastric lymph nodes with malignant criteria in five patients in group A and 3 patients in group B, signs of chronic #ion with multiple malignant paragastric lymph nodes in four patients in group A and 2 patients group B and gastric involvement with lymphoma and malignant paragastric lymph nodes in one patient both groups. No abnormal findings were detected in 4 patients in group B. In conclusion: EUS is a reliable tool for detection of gastric involvement and staging of NHL even without gastric symptoms and endoscopic findings

Renal dysfunction in liver cirrhosis: renal duplex doppler us vs. scintigraphy for early identification

Renal arteries of 43 patients with cirrhosis and normal renal function tests were compared with 15 age and gender matched normal subjects as a control group using color Doppler sonography and Tc- 99m DTPA scintigraphy. The patients were categorized into three groups: A [14], B [14] and C [15] according to a modified Child's classification that assesses the severity of liver cirrhosis. Doppler sonography can detect an increase in renal vascular resistance in patients with moderately severe cirrhosis [Child B] when renography was normal. It was concluded that Doppler sonography can be used for earlier identification of cirrhotic patients with a higher risk of impeding renal failure earlier than renography and may also be used to guide therapeutic approaches

Clinical value of mutant P53 protein levels, purine and pyrimidine metabolizing enzymes and lysosomal enzymes in gastric cancer

Mutant P53 protein levels, purine metabolizing enzymes [adenosine deaminase[ADA], guanosine deaminase [GUA]], the pyrimidine metabolizing enzyme [cytidine deaminase [CDA]] as well as lysosomal enzymes [acid phosphatase, cathepsin D and aryl sulfatase] were determined biochemically in homogenates of 34 histologically proven gastric cancer endoscopic biopsy samples as well as 11 non-cancerous mucosal biopsy specimens from patients with localized tumors at least 2 cm apart from the lesion as a control group. From the results obtained, determination of mutant P35 protein levels in endoscopic biopsy samples before treatment is greatly helpful in detecting patients with advanced and aggressive tumors requiring special treatment modalities. Based on the results of purine and pyrimidine metabolizing enzymes, the use of new therapeutic interventions in the form of ADA inhibitors may be of a value in gastric cancer patients. The use of cathepsin D inhibitors seems to be valuable for patients with gastric cancer

Anticardiolipin antibodies and cellular bronchoalveolar lavage as active tools for early diagnosis of subclinical pulmonary involvement in rheumatoid arthritis

Subclinical pulmonary involvement in rheumatoid arthritis [RA] was assessed by anticardiolipin antibodies [ACA] estimation in 30 patients and cellular bronchoalveolar lavage analysis [BAL] in 20 of them. All patients had no clinical manifestations of pulmonary involvement and had normal chest roentgenograms, normal pulmonary function tests and normal blood gases. Abnormal differential BAL count was detected in 35% of the 20 studied patients, 86% of them had lymphocytic alveolitis and 29% had neutrophilic alveolitis. So, BAL could used as a sensitive tool in detecting early pulmonary involvement in RA. High IgG ACA and/or IgM ACA were present in sera of 27% of the 30 patients. There was significant association between BAL abnormalities and the severity of RA as demonstrated by C-reactive protein level. High ACA level was found in patients with severe RA as demonstrated by presence of one or more extra-articular manifestations in 88% and high C-reactive protein in all of them compared with those with normal ACA level. Patients with abnormal BAL had significant high ACA [IgA and/or IgM] than those with normal BAL. The study suggested that BAL in addition to ACA analysis are of value in the early diagnosis of pulmonary involvement in patients with RA for early therapeutic intervention before the development of irreversible lesions

Renal artery stenosis as a cause of secondary treatable hypertension: Colour and duplex doppler evaluation, diagnostic criteria and efficacy

Renal artery stenosis is the cause of hypertension in a small percentage of all patients with hypertension, but is the only anatomic cause that can be treated by surgery or angioplasty. Recent studies indicated that Doppler characteristics aided with color Doppler imaging is an adequate screening method for such cases. This study aimed to evaluate the use and feasibility of color and duplex Doppler scanning and its criteria for detection and evaluation of renal artery stenosis as a cause of h hypertension. The renal artery was studied by this method all over its whole course in 32 patients, selected clinically with a hypertension suggested to be of renovascular origin. Another ten normal cases were studied as a representative of normal findings used for comparison. Transfemoral aortography [aortic flush angiography] was used for confirmation of the ultrasonography [US] findings and assessment of the degree of renal artery stenosis. The findings defined the use of three parameters concomitantly to give an accurate identification of the renal artery stenosis. Also, it showed that these parameters together [peak velocity, pulsatility index and resistivity index] had a high sensitivity, specificity, positive predictive value, negative predictive value and an overall accuracy of 100%, 86.96%, 84.21%, 95.2% and 92.3%, respectively, for renal artery disease detection. It was concluded that duplex aided with color Doppler US study of renal arteries of hypertensive patients can reliably detect renal artery stenosis, that can be therefore a valuable tool in selection of hypertensive patients for angiography and for either angioplasty or surgical management

Sex hormone profile in male diabetics, its relationship with sexual dysfunction

To investigate endocrinological changes associated with diabetes mellitus, serum total and free testosterone [T], estradiol [E [2]], lutenizing hormone [LH], follicle stimulating hormone [FSH] and prolactin [Prl] were determined in 39 male diabetic subjects [7 with type I and 32 with type II diabetes]. In addition to 14 healthy males of comparable age. Serum total and free T were significantly reduced but serum E [2], LH and Prl were significantly increased while FSH exhibited non-significant increase in diabetic subjects compared with healthy males. Neither did the type of diabetes nor its duration affect the hormonal levels. Similarly, no significant differences could be observed in the hormonal profiles between complicated and non-complicated diabetics. However, serum total and free T were significantly decreased in impotent compared to non-impotent diabetics. Serum total T levels exhibited a significant inverse correlation with blood glucose levels, but were not correlated with the age of the patients or with the duration of disease. The results of the present work demonstrated the presence of changes in sex hormone levels in male diabetics that could contribute to sexual dysfunction. Hyperglycaemia seems to be one of the causative factors for such changes and the use. of oral antidiabetic agents may be an added factor

Assessment of biochemical and hematological changes in dialysis patients in Najd, Saudi Arabia a four-year experience

This study was performed on 50 patients with end stage renal disease. They included 15 patients with diabetic nephropathy, 15 patients with glomerulonephritis, 15 patients with hypertensive nephropathy, 2 patient with systemic lupus erythematosus and the remaining 3 patients, one had tuberculous pyelonephritis, one had sickle cell haemoglobinopathy and one had myelomatosis. These patients were treated with dialysis, 10 patients subjected to intermittent peritoneal dialysis and 40 patients were treated with haemodialysis twice weekly and were followed up for 4 years. Blood urea, serum creatinine, sodium, potassium, phosphorus, uric acid, calcium, magnesium, liver function tests and blood glucose together with full blood picture, platelet count and blood group were done for every patients before and after every dialysis for four years. Hepatitis B surface antigen was done for every patient. It was found that peritoneal dialysis was better than haemodialysis in treatment of these patients as evidenced by biochemical and hematological data. Anaemia was present in all patients but this was not grossly affected by dialysis. A nonsignificant increase in platelet count was observed after peritoneal dialysis while a nonsignificant decrease was observed after haemodialysis. All the patients were Rhesus positive, 58% of them were group 0. No more seroconversion for hepatitis B occurred during the four years of the study. Arthropathy was recorded in 4% of our cases. There were two fatalities during the period of the study, one due to cancer colon and the other due to non-Hodglin's lymphoma

Ultrasonography in diagnosis of superior mesenteric artery syndrome [SMAS] as a cause of dyspepsia in young asthenic females

Thirty selected female patients with SMAS suffering from dyspepsia in the form of post-prandial epigastric pain, distension nausea and vomiting were studied. Other causes of dyspepsia were excluded. We examined superior mesenteric artery at its origin from abdominal aorta by ultrasonography in longitudinal and transverse sections and estimated the distance and angle between it and the aorta. The results were compared with those of 10 normal fermales. The distance between SMA and aorta was found to be 2-3 mm with a mean of 2.5 mm in patients with SMAS compared to 10-20 mm with a mean of 18mm in controls. Also the angle between SMA and aorta was from 10-20