Chronic liver disease among Egyptian military persons: contribution of hepatitis virus infections

In Egypt, viral hepatitis is the major cause of chronic liver disease and liver cirrhosis. The aim of this work is to estimate the frequency of hepatitis virus infections among military persons with chronic liver disease. One hundred and ten male military personnel having chronic liver disease [CLD] were subjected to laboratory investigations including hepatitis viral markers, abdominal ultrasonography and liver biopsy. They were divided into three groups according to results of hepatitis B virus [HBV] and hepatitis C virus [HCV] seromarkers. Group I comprised 31 patients [28.2%] who had evidence of HBV infection, group II comprised 53 patients [48,2%] who had evidence of HCV infection, and group III comprised 26 patients [23.6%] who had evidence of both HBV and HCV infection. Age group

Pharmacokinetics of digoxin in patients with atrial fibrillation: role of the classic co-variables

This work was performed to study the pharmacokinetics of digoxin in patients suffering from atrial fibrillation [AF] after optimization of all the known classic factors contributing to inter-patient variability in serum digoxin levels, to detect if any variability in serum digoxin levels still exists or this variability is only a function of the classic co-variables so that their optimization will diminish or eliminate it. Twenty male patients suffering from AF, were selected from the Critical Care Medicine Department, Cairo University Hospitals to be enrolled in the study. A patient is initially considered to be a candidate for this study when digoxin therapy was indicated. Patients were selected to have non-significant variations in their demographics and pretreatment clinical data. Blood samples were drawn from each patient at specified intervals and the serum fractions were separated and assayed for digoxin, using digoxin enzyme multiple immunoassay technique [Emit 2000]. The results revealed unpredictable variability in serum digoxin levels among patients at each sampling time and a marked inter-patient variability in mean serum digoxin levels among individuals throughout the twenty four hours, [P value: 0.0001].Considerable inter-patient variability was also evident in digoxin pharmacokinetics. Digoxin was rapidly absorbed after dosage administration, with C[max] occurring at 0.5 to 1.0 hour in all patients. Mean T[max] was 0.575 +/- 0.18 hr. Digoxin C[max] varied from 0.86 to 6.72 ng/ml with a mean value of 3.99 +/- 1.91 ng/ml. AUC also varied greatly among patients [from 6.16 ng hr/ml to 112.14 ng hr/ml] with a mean value of 49.47 +/- 30.344 ng/hr/ml. The elimination half-life [t[1/2]] varied from 0.86 days to 7.16 days with a mean value of 2.66 +/- 1.45 days. The overall mean oral clearance also showed a great variability among patients with a mean of 9.3 +/- 8.7 ml/hr/kg [CV: 92.9%]. In conclusion: variability in serum digoxin concentrations and digoxin pharmacokinetics existed in spite of careful patient selection and optimization of all the classic co-variables known to affect digoxin concentrations, suggesting the presence of other unstudied factors; the recently evolving genetic factors might contribute to this variability

value of transesophageal echocardiography in the assessment of the degree of mitral regurgitation

Accurate evaluation of the severity of mitral regurgitation [MR] is of paramount importance for decision making for a patient who may undergo heart surgery. This study was aimed to evaluating the accuracy of transesophageal echocardiography [TEE] in the assessment of the severity of MR. Fifty patients with different grades and etiologies of MR underwent clinical examination, electrocardiography, plain X- ray, transthoracic echocardiography [TTE] and TEE. Left ventriculography was also performed as a gold standard to estimate the degree of MR. Sensitivity and specificity of TEE and TTE in the assessment of the different grades of MR were calculated using left ventriculography as a gold standard. The relationship between the maximum mosaic jet area of MR by TTE and TEE showed a significant difference with a good correlation. It was concluded that TEE is a highly sensitive and specific technique not only in detection of MR, but also in evaluating its severity

Endotoxemia in patients with chronic liver disease

This study was conducted on 100 selected patients with chonic liver disease to find the relationship between plasma endotoxin level and the severity of liver disease. Twenty normal controls were in the study for Comparison. Patients were classified according to Child Classification into Child A group [30 Patients] and Child Band C groups [70 Patients]. Endotoxin level was assayed in the plasma of patients and controls using a quantitative chromogenic Limulus Amaebocyte Lysate Test [LAL]. The level of endotoxin was significantly in Child groups A, B and C than in the normal controls. Also it was found that the level of endotoxin in Child group B and C was significantly higher than in group A [P<0.05]. The endotoxin level was also significantly higher in cases with cirrhotic or mixed pattern than in those with schistosomal pattern [p=0.05]. It was found that the level of endotoxin correlated significantly with the incidence of ascites. It was concluded that endotoxaemia becomes more prominent with the progression of liver disease especially when associated with a mixed aetiology which may have its impact on the hepatic state and extrahepatic manifestationss

New antigen and antibody detection methods for serodiagnosis of human tuberculous

The present work aimed to develop enzyme linked immunosorbent assay [ELISA] for early diagnosis of pulmonary TB by detection of Mycobacterium tuberculosis [M. tuberculosis] antigen and/or antibody in serum of TB patients, contacts and healthy controls. The study was performed on 4 groups of subjects: Egyptian pulmonary TB patients [12], Egyptian contacts of TB patients [10], Egyptian normals [7] and Birmingham normals [5]. Sera from patients, contacts and controls were used for detection of M. tuberculosis antigen in serum immune complexes by sandwich ELISA using DEAE purified rabbit anti-M. tuberculosis H37 RV IgG antibody. Detection of antibodies in serum was done using purified recombinant M. tuberculosis superoxide dismutase [SOD]. By antigen capture ELISA 10 of the 12 Egyptian patients and one of each of the Egyptian contacts and controls tested proved positive. All Birmingham normals were negative. The antibody levels to mycobacterial SOD antigens in TB patients and controls showed a significant rise in level of antibodies in sera of pulmonary TB patients than in the healthy controls. This study indicated that, serodiagnosis by antigen detection in TB patients sera using DEAE purified rabbit anti-M. tuberculosis H37 RV IgG antibodies is reliable and could be used as an alternative test than sophisticated assays as DNA probes and PCR. Regarding the value of serodiagnosis by detection of anti-SOD antibodies, it seems to be a promising test but needs further evaluation

Transfusion associated hepatitis in patients with schistosomiasis

The study population [208 subjects] was divided into four groups in relation to the risk of blood transfusion. Schistosomal patients comprised two groups; one with previous history of blood transfusion [n: 61] and the other gave no history of past exposure to transfusion [n: 50]. Non schistosomal subjects included 42 patients with history of repeated transfusion and 55 healthy controls with no apparent parenteral risks. Hepatitis markers B, D and C were assayed using enzyme immunoassay [EIA]. Serum samples reactive by HCV EIA were further tested with recombinant immunoblot assay [RIBA-2]. A significantly higher HB carrier state [positive HBs Ag] was observed among the schistosomol group whereas, markers of previous exposure to HBV [anti-HBs, total anti Hbc and anti-HBe] were not significantly different among schistosomal groups and transfused non schistosomal ones, yet they differed significantly from the healthy controls. Anti-HCV seroprevalence was significantly higher among schistosomal and transfused non-schistosomal groups than the control group with a recorded good correlation between second generation EIA and RIbA tests. Schistosomiasis is believed to be a potent risk factor for HB and HCV infection and is comparable to the risk of transfusion. It is also considered to be a major cause of persistance and superinfection with hepatitis virus infection

Twelve years experience of permanent pacemaker malfunctions at Cairo University

This study aimed to evaluate the types of pacemaker malfunctions. Out of 578 patients who had permanent PMs, 486 [84.1%] were available for follow up for a mean period of 53 +/- 10.3 months [range from 2 to 130 months]. Pacemaker complications were classified into those due to generator malfunctions and those due to lead problems. The entire period of follow up was divided into first 6 years [82-87] and second 6 years [88-93]. Methods of diagnosis included history, resting 12 lead ECG, magnet test, electronic testing, telemetry, plain X-ray chest, ambulatory ECG, chest wall stimulation, provocative maneuver and lastly invasive testing. From the results obtained it was concluded that increasing rate of implantation with progressive shift from non-programmable to more sophisticated physiologic pacemakers imposed an additional task on implanting physician; namely, diagnosis and mangement of pacemaker malfunctions. Lead problems in the second period of follow up were almost thrice the generator malfunctions reflecting the learning curve of the new generation of operators. However, the increasing incidence of generator malfunctions is related to the longer follow up and better longevity of patients

Psychological and psychiatric aspects of chronic pain syndrome

Recent research in the field of chronic pain has highlighted the importance of the assessment of psychological factors as part of the overall assessment of chronic pain patients. Psychological factors come into play not only in the genesis| of the chronic pain syndrome but also in the kind of behaviour displayed by the sufferer in obtaining or not obtaining the kind of help he thinks he needs. The psychological meaning of pain on the intra-personal level and the societal response to those who complain of pain [the inter-personal response] can greatly affect the way people respond to and develop into chronic pain sufferers. Psychiatrists and psychologists have also contributed to the classification and more refined diagnosis of chronic pain syndromes. A number of different approaches have been taken to make a psychological evaluation ranging from formal assessment of psychiatric illness to self-report questionnaires and clinical evaluation. Furthermore psychological therapies and psychotropic medication now constitute a main part of the modern approach to chronic pain syndrome management. The local cultural and personal factors which can affect the chronic pain syndromes in their development and their management are examined. Finally, some general recommendations for the better management of chronic pain syndrome patients are made

Yersinia enterocolitica infection in patients with schistosomiasis

This study was carried out on 4 groups of subjects: group I included 54 bilharzial patients, group II 118 patients suffering from gastroenteritis, group III 62 pig's contacts, group IV 40 healthy individuals. The results of stool culture revealed only 3 positive cases among the diseased groups, contracts and healthy controls making an incidence of 1.7%. The IHA test showed a higher percentage of positivity [38.7%] in the group of pig's contact than the other groups, also the rate of positivity in bilharzial patients is higher than in patients of gastroenteritis [11.1% and 5.9% respectively]. ELISA showed the same sequence of positivity as IHA. The results of ELISA and IHA showed a fair agreement by Kappa measure, however, ELISA is more specific as out of 39 serum samples which gave positive IHA, 6 samples showed Brucella Abs and only 2 of them gave positive ELISA

Serum magnesium in critically ill cardiac patients: prevalence and prognostic implications

Serum levels of magnesium [Mg] and potassium [K] have been measured in 100 critically ill cardiac patients [pts] consecutively admitted to the Critical Care Center of Cairo University including 70 males, 30 females whose ages ranged from 25 to 78 [mean 52 years]. Diagnoses included acute myocardial infarction [AMI] in 50 pts, and miscellaneous cardiac disorders [without infarction] in the other 50 pts. Serum electrolytes [Mg and K] were measured daily on admission, whenever possible and at times of crises. The prevalence of hypomagnesemia in the two groups of patients was 56%, and that of hypokalemia was 34%. The incidence of ventricular arrhythmias in normomagnesemic AMI pts was 18.2% compared with 39.2% in hypomagnesemic pts with AIMI, with p-value 0.05 and 2.15 relative risk. There was a 41.1% incidence of ventricular arrhythmias with hypokalemia in AMI pts against 22.6% of the normokaliemic AMI pts, with p-value 0.07 and 1.86 relative risk. The AMI pts have a significantly higher incidence of ventricular arrhythmias in the patients with both Mg and K deficiencies [53.9%], than pts with single electrolyte deficiency [23.8%] or without electrolyte abnormalities [18.8%], p= 0.02. On the other hand, in the other cardiac disease, there was no significant difference between pts with arrhythmias and those without, in terms of hypo Mg and K. The mortality rate, however, of any group of pts showed no significant deviations when each electrolyte was analyzed separately