Serum ANCA versus endoscopic histopathological findings in diagnosis of patients with ulcerative colitis

Ulcerative colitis [UC] is defined as continuous idiopathic inflammation of colonic mucosa that begins in the rectal area and may extend through the entire large bowel. The diagnosis of UC depends on clinical picture, stool analysis, endoscopie appearance and histopathological assessment of endoscopic biopsy. The aim of this work was to assess the value of pANCA in the diagnosis of UC as a non-invasive diagnostic tool versus the endoscopie and histoapathological examinations This study included seventy patients which were grouped into three groups: Group [I]: Included 20 patients with UC [13 males and 7 females with mean age of 28, 7 +/- 9.83 years], Group[II]: Included 20 patients with nonspecific colitis [8 males and 12 females with mean age of 40.4 +/- 10.8 years] and Group[III] that Included 30 subjects with normal lower endoscopy as control group [18 males and 12 females with mean of age 27l +/- 6.llyears]. All patients were subjected to thorough history taking. full clinical examination, urine analysis. stool examination and culture, ESR, CRP, complete blood picture. serum iron, liver function tests, renal function tests, abdominal plain X-ray, abdominal ultrasound, lower endoscopic and histopathological examinations, pANCA detection by ELISA and confirmed by IF technique Perinuclear anti nuetrophil cytoplasmic antibodies [pANCA] detected by ELISA were positive in 75% of UC patients and in 10% of non specific colitis patients while all control group subjects were negative. pANCA detected by ELISA had 75% sensitivity. 95% specificity, 88.2°/a positive predictive value and 90.5% negative predictive value for ulcerative colitis patients pANCA detected by IF technique were positive in 85% of UC patients and 25% of non specific colitis patients while none of control group was positive. pANCA by I had 85% sensitivity, 90% specificity. 77.3% positive predictive value and 93.7% negative predictive value for ulcerative colitis patients Conclusion pANCA is a beneficial senomarker detected in 75%-85% of patients with ulcerative colitis. pANCA detected by ELISA technique has high specificity and relatively low sensitivity for ulcerative colitis. Combined ELISA and IF technique for detection of pANCA may add higher sensitivity for pANCA as a seromaker for diagnosis of ulcerative colitis and can be used as a non invasive tool for diagnosis of ulcerative colitis especially when lower cndoscopy is contraindieated

Cigarette smoking may aggravate liver disease in patients with hepatitis C virus [HCV] infection

Egypt has a high prevalence of hepatitis C virus [HCV] infection, resulting in a high morbidity and mortality from chronic hepatitis, cirrhosia, and hepathocellular carcinoma. It is unclear why some patients with HCV infection do better than others with the same physical and epidemiological characteristics, Recently, environmental pollution was accused in many chronic diseases including liver disease. We designed this study to clarify the impact of heavy metals and oxidative stress in cigarette smoke on liver disease in HCV patients. Fifty male Egyptian patients with positive HCV-RNA were studied. Twenty-five of them were smokers with an average smoking index of 183.16 and the other 53 were non-smokers. Both groups were matched as regards age and have no home or occupational exposure to heavy metals. The antioxidant defense system of erythrocytes, liver function tests, serum trace elements, and serum heavy metals were measured for all patients. A significant increase in serum cadmium and lead was found in smoker patients. Also, the liver enzymes [alanine aminotranserferase; ALT, aspartate aminotranseferase; AST, and alkaline phosphatase; ALP], were significantly elevated in the serum of smoker patients. The histologic activity index [HAI] was higher in smokers than non-smoker patients, but the difference was statistically non-significant. On the other hand, a significant decrease in serum albumin and serum selenium was found in smoker patients. Also, the activities of the antioxidant enzymes in the erythrocytes [glutathione reductase; GR, superoxide dismutase; SOD, catalase; CAT, and reduced glutathione; GSH] were significantly lower in smoker than non-smoker patients. The results of this study concluded that patients with hepatitis C should be informed about the possible hepatotoxsicity of heavy metals and oxidants in cigarette smoke and advised to quit smoking as a part of their life style modification. Further studies are encouraged to discover other aspects of tobacco toxicities on the human liver and the pathogenesis of this potential harmful effect

Ultrastructural mucosal changes in patients with ulcerative colitis

The present study included 15 patients with ulcerative colitis in various degrees of severity [mild, moderate and severe] and 5 healthy individuals as a control group to assess the ultrascructural changes of the mucosa in ulcerative colitis patients. Full length colonoscopic examination was done to all patients. Mucosal biopsies were taken from the inflamed mucosa and processed for histological and electron microscopic examination. These biopsies were compared with similarly processed ones from controls. The study showed the presence of ultrastructural mucosal changes in ulcerative colitis patents in the form of mitochondrial swelling, lack of microvilli, multiple secondary lysosomes, swollen goblet cells, peripheral condensation of nuclear chromatin, loss of tight junction and infiltration of the inflamed mucosa and epithelium with eosinophils. These changes were more frequent as the disease increases in severity. Dysplasia - like changes such as indentation of the nucleus, peripheral condensation of chromatin and flattening of cells were demonstrated in only two patients with severe and long-term U.C. The control biopsies appeared to be ultrastructurally normal. In conclusion, ulcerative colitis is associated with many ultrastructural mucosal Changes which are more frequent as the disease increases [progresses] in severity. These changes may be involved in the pathogenesis of ulcerative colitis and its related neoplasia