Prognostic value of serum soluble interleukin-2 receptor in Egyptian chronic hepatitis c patients treated with pegylated interferon and ribavirin

Hepatitis C virus [HCV] is a major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwide. A strong Thl response seems to be associated with viral clearance. It is generally accepted that T cell activation is characterized by the synthesis and secretion of interleukin-2 and by the expression of Interleukin-2 receptors [IL-2R] on the cell surface of immune cells. The aim of this study is to determine the evolution of soluble IL-2 receptors [sIL2-R], as an indicator of activation of T cells in HCV patients treated with ribavirin and pegylated interferon and its correlation with outcome of therapy. 53 naive [previously not treated] chronic HCV patients eligible for criteria of therapy according to the international guidelines were recruited. Pegylated interferon alpha-2a [IFNalpha-2a] was used subcutaneously once a week for 48 weeks. Ribavirin tablets in a dose of 13mg/kg were given daily in 2 divided doses Liver function and complete blood picture were monitored weekly for the first month and then monthly in the course of administration of therapy. HCV-RNA was monitored every 3 month. Sera were collected at different time point before and during therapy and tested for level of soluble IL2-R using ELISA techniques. Prior to therapy, mean serum soluble IL-2R level was significantly higher in patients with HCV as compared to controls [3709.05 +/- 291.4 pg/ml versus 1770.6 pg/ml +/- 220.3, p<0.01]. After end of therapy, patients were retrospectively classified into 2 groups, responders and non-responders. In responders, the level of sIL-2R raised significantly after 4 weeks of therapy as compared to pre-treatment level [4501 +/- 309 pg/ml versus 3550 +/- 291 pg/ml p= 0.01]. In non-responders, however, the difference in serum sIL2R before therapy and after 4 weeks of therapy was non-significant [4021 +/- 567 pg/ml versus 3934 +/- 550 pg/ml p=0.9]. The levels of serum sIL2-R significantly correlated in a linear model with ALT levels before starting the therapy. Monitoring of sIL-2R levels may therefore be of value as an adjunct to the measurement of serum ALT and HCV-RNA in predicting the response to interferon therapy in HCV patients

Histopathological features of chronic hepatitis C in Egyptian patients

Chronic liver disease including that caused by the hepatitis C virus progresses in stages. It can range from inflammation, to fibrosis to end stage liver disease or liver cancer. This work aimed to study the histopathological features of chronic hepatitis C infected Egyptian patients followed-up at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. The study included 4267 liver biopsies from patients with serological and virological diagnosis of chronic HCV with no other identifiable cause for liver disease, signs of hepatic decomposition, or other significant non-hepatic disease. All biopsies were fixed in formalin, embedded in paraffin, and sectioned by microtome with a thickness of 5 micro m. Routine specimen processing involved staining slides with hematoxylin and eosin [5 levels] and Masson's trichrome stain [5 levels], for a total of 10 levels per specimen. All levels were screened by two pathologists to ensure the histological abnormalities. Ishak scoring system was applied for assessment of fibrosis and necroinflammatory injury. The percentage of hepatocytes involved by fatty changes was used to score the grade of steatosis. The relations between the histopathological findings, age and sex of the patients were carried out. The studied group [n = 4267] involved 3268 males and 999 female, with age ranging from 21 to 60 years and a mean of 41.7 +/- 9.7 years. Necroinflammatory activity of the virus was minimal in 17.88%, mild in 56.41%, moderate in 22.24% and severe in 3.47%. No fibrous tissue deposition was seen in 21 patients [0.49%], 27.32% of the patients had portal and periportal fibrous expansion, 27.91% had fibrous extensions with occasional thin fibrous tissue bridge, 36.28% had frequent broad fibrous tissue septa, while 7.99% of the studied group of patients had cirrhosis. Steatosis was absent in 52.45% of cases, mild in 39.75%, moderate in 7.19% and severe in 0.61% of patients. Non-specific granulomatous reaction was detected in 11 liver biopsies [9 males and 2 females]. Fibrosis and necroinflammation were more frequent in older patients. No significant difference between males and females regarding fibrosis, but females were more exposed to higher grades of necroinflammation [p < 0.001]. Chronic hepatitis C infection is a common and serious health problem that progresses to fibrosis, cirrhosis, liver failure and hepatocelluar carcinoma. Portal lymphoid infiltrate and minor hepatocellular necrosis were present in almost all cases. Necroinflammatory activity was mild in nearly half of the cases. Steatosis was detected in 47.55% of the patients. Fibrosis and necroinflammation were more frequent in older patients. Non-specific granulomas were rarely encountered in association with hepatitis C

serological gastric biopsy: a non-endoscopical/histopathologic diagnostic approach in management of the dyspeptic patients

Objective: To assess the sensitivity, specificity and the predictive value of a 'gastropanel' blood test, including serum pepsinogen I [S-PGI] and amidated gastrin-17 [S-G-17] in the diagnosis of atrophic gastritis most probably due to helicobacter pylon [Hp] and to compare the results of serology with the endoscopic/histopathologic findings as a gold standard diagnostic tool

Subjects and Methods: This study comprised 86 dyspeptic outpatients who underwent a diagnostic gastroscopy with multiple biopsies from the antrum and corpus for histopathologic examination. Histopathologically, the series of cases included 46 patients diagnosed as having atrophic gastritis. Twenty five had an antral atrophy, 6 had corpus atrophy and 15 patients had an atrophic gastritis in both the antrum and corpus [multi local atrophic gastritis] MAG. The remaining 40 cases were considered as controls, 32 had a non-atrophic gastritis [NAG] and both the antrum and corpus were normal and healthy in 8 subjects. The fasting levels of S-PGI and antibodies to Hp lgG-antibodies [S-UpAb] and postprandial amidated S-G-17 [S-G-17prand] were measured 20 min after a protein-rich drink and were determined using enzyme immunoassay [EIA] methods. The serologic and morphologic results were compared with estimating the sensitivity, specificity, positive and negative predictive [PPV and NPV] and accuracy values of the tests [S-G-17 and S-PGI]

Results: Mean values of both S-G-17prand and S-PGI decreased with increasing grade of antral and corpus atrophy, respectively. A low S-PGI [<25 microg/I] was found in 4 of 6 patients with corpus atrophy [66.70%] and in 5 of 32 [15.62%] patients with NAG in the biopsy specimens. A low S-G-17prand [<5 pmol/l] was found in 13 patients with Hp-associated antral atrophy and in 5 of 32 [15.62%] patients with NAG. The diagnosis of gastritis obtained with the blood test panel is in good agreement with the endoscopic and biopsy findings: 92% of the patients went into same gastritis categories with both the panel and endoscopic/histopathologic findings. The sensitivity, specificity, PPV, NPV and accuracy values of the blood test panel [S-G-17prand and S-PGI] in delineation of patients with atrophic gastritis [either in the antrum or the corpus, or both] versus NAG and normal stomach were 87.5%, 82.60%, 8 1.40%, 88.40% and 85%, respectively

Conclusion: Low levels of S-G-17prand and S-PGI are conceivable biomarkers of atrophic gastritis. The serologic method gave a reasonable sensitivity, specificity, PPV. NPV and accuracy values in the diagnosis of atrophic gastritis. So, it may be offered as the screening tool for atrophic gastritis

Analysis of four different methods for the detection of helicobacter pylori infection in patients with dyspepsia

Helicobacter pylori [H.pylori] is a major causative agent of chronic gastritis and peptic ulcer disease. Furthermore, H.pylori plays an important role in the pathogenesis of gastric cancer and gastric mucosa-associated lymphoid tissue [MALT] lymphoma. So the accurate diagnosis of the H.pylori infection is of clinical importance to compare the accuracy of four tests, including culture, histopathology, rapid urease test and serology for the diagnosis of H.pylori infection in patients with dyspepsia. National Hepatology and Tropical Medicine Research Institute. Prospective study. Sixty patients complaining of dyspepsia and undergoing upper endoscopy were included in the study, three antrum biopsy specimens were taken from each patient for rapid urease test, histopathological examination and culture. Blood samples were taken after endoscopic examination and sera were separated by centrifugation and stored at -70C until analyzed. A total of 60 patients were included in this study, 24 males and 36 females. Their age ranged from 23-65 years, histopathology was positive in 45 patients [75%]. Rapid urease test was positive in 36 patients [60%]. Culture was positive in 24 patients [40%] and Serology was positive in 45 patients [75%]. We found that If endoscopy was to be performed, a biopsy urease test was recommended as the test of first choice, with histology recommended only in negative cases. Culture is recommended in treatment-resistant cases to allow testing for antibiotic susceptibility. If endoscopy is not to be performed, serology is also an accurate test, but coupling it with testing of virulence strains is preferred to avoid unnecessary treatment

Carriage sand an tibiotic resistance of S. pneumoniae, H. influenzae and M. catarrhalis colonizing the nasopharynx of children

Data about the carriage rate and antibiotic resistance pattern in the common respiratory pathogens Streptococcuspneumoniae, Haemophilus influenzae and Moraxella catarrhalis is variable from country to the other. The aim of our study was to evaluate these data in our country. It was found that the carriage rate is higher in children attending daycare centers; S.pneumoniae was the most commonly isolated organism followed by M.catarrhalis and finally H.influenzae. Penicillin resistant S.pneumoniae was discovered in 57 percent of positive cases, Beta-lactamase producing M.catarrhalis was also discovered in about 50 percent of isolates. Resistance to penicillin in S.pneumoniae isolates led to a higher rate of resistance to other antibiotics as well such as Cefotaxime, Azithromycin and Co-trimoxazole. It is to be noted that resistance to various antibiotics differed from one country to the other