Diagnostic yield of estimation of serum complexed PSA as a screening tool for prostate cancer patients

The present study aimed to evaluate the diagnostic yield of estimation of complexed prostate-specific antigen [cPSA] in random sample of patients with symptoms suggestive of prostate cancer [PC] and had serum PSA of 2.5-20 ng/ml and no previous histologic proof of prostate cancer. All patients underwent full history taking, complete physical examination and prior to prostatic examination or any manipulations, venous blood samples were collected for ELISA estimation PSA serum levels. Then, patients underwent trans-rectal ultrasonography [TRUS] to assess the prostate and the adenoma volume and the peripheral zone [PZ] of the prostate was checked. All patients underwent 10-core TRUS-biopsy taking from the peripheral zone ofthe prostate. The study included 223 male patients fulfilled the inclusion criteria of the study with mean age of 65.7 +/- 8 years. Mean prostatic volume was 60.1 +/- 14.8 cm3 and the mean PZ calculated volume was 41.8 +/- 9.4 cm3. Histopathological examination of core biopsies defined 23 cases with PC [PC group] with a frequency of cancer detection of 10.3% while the other 200 patients were free of PC [Control group]. Mean estimated serum tPSA and cPSA levels were significantly higher in PC group compared to its level estimated in control group, while serum fPSA levels were non-significantly lower in PC group compared to control group. Mean PSA densities [PSAD, PZ PSAD, cPSAD and PZ cPSAD] were significantly higher in PC group compared to control group. There was a positive significant correlation between the presence of PC and age of patients and with levels and densities of tPSA and cPSA. Using ROC curve analysis to define the most specific predictors of presence of PC revealed that cPSA level was highly specific with AUC=0.987 with a significant difference in favor of cPSA level in comparison to tPSA and fPSA. Using regression analysis defined cPSA level PZ cPSAD and PZ PSAD as the significant predictors of PC and ROC curve analysis of the three parameters defined PZ cPSAD and cPSA serum level as the highest specific predictors of PC. It could be concluded that estimation of serum complexed PSA could define cases of PC with high specificity during screening of patients had serum PSA levels ranged between 2.5 and 20 ng/ml and used in combination with determination of PZ cPSAD are highly significant specific predictors of PC

Viral hepatitis c infectivity of nasal secretion: PCR evaluation

The present study aimed to evaluate the prevalence of hepatitis C virus [HCV] infection in nasal lavage [NL] fluid of patients had no history of previous HCV infection. The study was designed as a 2-arm screening study: Group N included 200 randomly chosen patients and started by testing NL fluid for presence of anti-HCV antibodies [anti-HCV Ab] and those with positive result underwent determination of sero-positivity. The other arm consisted of another patients' group [Group S; n=200] underwent determination of sero-positivity, and those proved positive underwent determination of positivity of their NL fluid for anti-HCV Ab. PCR identification of HCV RNA was conducted for all positive sera and NL fluid. Anti-HCV Ab were detected in NL fluid of 7 patients with detection rate of 3.8% and in serum samples of 10 patients with a detection rate of 5% and an overall detection rate of patients with anti-HCV positive of 4.4%. The 7 patients with anti-HCV Ab positive NL fluid were sero-positive; while only 6 of the 10 sero-positive patients had anti-HCV Ab positive NL fluid, thus, determination of anti-HCV Ab in NL fluid could detect sero-positive patients with sensitivity rate of 76.4%. Qualitative PCR detection of HCV-RNA identified viral RNA in 14 serum samples; 13 samples were sero-positive and NL fluid positive and one was sero-positive but NL fluid negative, while the other 3 sero-positive samples were free of viral RNA. Thus, NL fluid anti-HCV Ab positivity could identify patients with viremia with sensitivity and accuracy rates of 92.8% and 94.1%, respectively and could exclude the presence of viremia with a negative predictive value of 75%. Using ROC curve analysis, defined determination of positivity of NL fluid as specific predictor for the presence of viremia with AUC=0.673, while sero-positivity showed AUC=0.500. To evaluate the infectivity of NL fluid, PCR identification of HCV viral R1VA in NL fluid was conducted for all NL fluid samples proved positive for antibodies and could detect HCV-RNA in 3 samples with infectivity rate of 17.6%.. It could be concluded that positivity for anti-HCV Ab was detected in 4.4% of the studied population supposed to be free of HCV infection and anti-HCV Ab determination in NL fluid could predict viremia with accuracy rate of 94.1% and could be considered as specific predictor with AUC=0.673 with an infectivity rate of NL fluid was 17.6%

Serum S100B and neuron-specific enolase as predictors of the neurologic disability status after traumatic brain injury

This study was designed to evaluate the correlation between serum levels of protein S100B and neuron-specific enolase [NSE] and the severity and outcome of traumatic brain injury [TBI] so as to be used as prognostic markers for cases admitted to Intensive care unit [ICU] after TBI. The study comprised 40 patients with head injury of varied severity and 10 volunteers [control group]. Inclusion criteria were head injury and presentation to the emergency department within 6 hours of injury. Initial injury severity was assessed using the Glasgow coma score [GCS] and all patients had cranial CT scans and lesions were evaluated with respect to lesion topography and territories of vascular supply. A venous blood sample was collected at admission for estimation of serum protein S100B and NSE levels. All patients received measures to decrease intracranial pressure [ICP] and phyntoin for posttraumatic seizures and underwent the appropriate neurosurgical procedure according to type of post-traumatic lesion. Follow-up was conducted monthly and the final outcome at six months was assessed using the Expanded Disability Status Scale [EDSS]. The mean initial GCS score was 11.1 +/- 3; 14 patients [35%] had mild, 17'patients [42.5%] had moderate and 9 patients [22.5%] had severe trauma. Normal CT was reported in 14 patients [35%]; however, CT scanning detected extradural hemorrhage in 5 patients [12.5%] fissure skull fracture in 5 patients [12.5%], fissure basal skull fracture in 3 patients [7.5%] and depressed skull fracture in 2 patients [5%]; while 3 patients [7.5%] had intracerebral hemorrhage and the other 8 patients had subdural hemorrhage, subdural hemorrhage with contusion, subdural hematoma and subarachnoid hemorrhage. Throughout follow-up, 18 patients [45%] had favorable outcome [EDSS<5]; while 22 patients had unfavorable outcome with EDSS >/= 5. Serum levels of S100B and NSE were significantly [P[1]<0.05] increased in patients compared to control levels, moreover, mean serum level of S100B was significantly [P[2]<0.05] and of NSE was non-significantly [P[2]>0.05] higher in patients with unfavorable outcome [EDSS >/=] compared to those with favorable outcome [EDSS<5] with a positive significant correlation between serum levels of S100B and NSE, [r = 0.485, p = 0.002]. Moreover, serum levels of both parameters showed a negative significant correlation with the initial GCS while showed a positive significant correlation with EDSS. However, there was a negative correlation between both parameters and the final outcome as favorable or unfavorable; such correlation was significant with S100B and non-significant with NSE. Using Logestic regression analysis serum S100B was the most significant predictor of the final outcome, [beta =-0.371, p = 0.018]. Receiver operator characteristics [ROC] curve analysis for serum levels of both S100B and NSE for prediction of favorable outcome found serum levels of S100B more specific with an area under curve [AUC] =0.379 than serum levels of NSE that found to be more sensitive with an AUC = 0.294. It could be concluded that estimation of serum S100B and NSE immediately after traumatic brain injury could define patients who will develop unfavorable outcome and posttraumatic disability with high sensitivity with NSE and specificity with S100 and must be used for the initial evaluation of TBI irrespective of the extent of severity of inflicted trauma

Non-cancerous thyroid lesions: immunologic and surgical evaluation

The present study was designed to determine T helper-l/T helper-2 [Th[1]/Th[2]] pattern in patients with Graves' disease [GD], benign multinodular goiter [MNG] and Hashimoto thyroiditis [HT] and evaluate the applicability of near-total thyroidectomy as a therapeutic strategy for surgical interference. The study included 75 patients [56 females and 19 males; with mean age of 43.8 +/- 8.2 years] with thyroid swelling and 15 healthy volunteers [control group]. Patients underwent clinical examination including direct laryngoscopy using fiberoptic endoscopy, laboratory investigations and ultrasonographic and [99m] Tc pertechnetate scintigraphy for establishment of diagnosis. Patients with HT received medical treatment and were followed-up, while patients with GD and MNG underwent near-total thyroidectomy. Preoperative blood samples were collected from patients and control subjects for ELISA estimation of serum levels of interleukin-2 [IL-2], IL-18, IL-4 and IL-5. Patients were observed for appearance of postoperative manifestations of recurrent laryngeal nerve [RLN] palsy and/or hypoparathyroidism. Mean operative time, duration of wound drainage and hospital stay were recorded. The study included 43 patients with GD [8 of them had thyroid orbitopathy], 17 patients had MNG and the remaining 15 patients had HT. All patients had smooth intraoperative course and no patient had permanent RLN palsy, but 4 [6.7%] patients had transient unilateral RLN palsies that recovered spontaneously after a mean duration of 24.5 +/- 11.6 days. Temporary hypocalcaemia occurred in 9 patients [15%] and permanent hypoparathyroidism resulted in one [1.7%]. All patients developed wound edema, 7 patients had wound seroma and 2 patients had wound infection. Mean serum levels of lL-2, IL-4 and IL-5 were significantly higher in patients compared to control levels irrespective of the type of thyroid lesion. Mean serum levels of IL-18 were significantly higher in patients with HT and MNG disease and non-significantly higher in patients with GD compared to control levels. Moreover, mean serum levels of IL-2 and IL-18 were significantly higher and mean serum levels of IL-4 and IL-5 were significantly lower in patients with HT and MNG disease compared to those with GD and in MNG patients compared to those with HT. The percentage of postoperative increase of serum IL-2 and IL-18 levels relative to the median control level were significantly higher in patients with HT than in patients with GD or MNG with a significantly higher percentage of increase in patients with MNG compared to those with GD. On the other hand, the percentages of increase of IL-4 and IL-5 were significantly higher in patients with GD compared to patients with HT or MNG with a significantly but non-significantly higher percentage of increase of IL-5 and IL-4, respectively, in patients with MNG compared to those with HT. It could be concluded that there was a disturbed pattern of Th[1]/Th[2] cytokines in patients with non-cancerous thyroid lesion in favor of humoral pattern of immune response in GD with predominance of Th[2] cytokines and a Th[1]-pattern of immune response characteristic of cellular immunity is dominant in HT. Also, near total thyroidectomy was found appropriate therapeutic modality with transient minimal complications for patients with MNG or GD

Resveratrol ameliorates experimentally-induced gentamicin nephrotoxicity: a biochemical and histological evaluation in rats

This experimental study aimed to investigate the possible effect of resveratrol [RSV], an antioxidant agent, during Gentamicin [GEN] treatment as a prophylactic modality against drug induced renal tubular affection. The study comprised 30 normal rats divided into 3 equal groups: Control group: Did not receive medications, GEN Group: Received IP injection of GEN [80mg/kg/day for 6 days] and RSV+GEN Group: Received IP injection of GEN [80mg/kg/day] and RSV [10mg/ kg/day for 6 days]. At the 6th day, blood samples were withdrawn for estimation of serum creatinine, urea and Na and K ions, then all animals were sacrificed and both kidneys were immediately removed and a renal cortex biopsy was obtained for estimation of renal tissue extract activity of glutathione [GSH], glutathione-S-transferase [GST], superoxide dismutase [SOD] and catalase [CAT] and tissue content of non-protein sulphydryl [NPSH] and lipid peroxides. Both kidneys were dissected out for histological studies and scored for seventy of tubular changes. In comparison to control group; GEN caused a significant elevation [p[1]<0.001] of serum urea and creatinifte associated with increased serum Na+ and decreased K+ levels with significantly increased levels of SOD, MDA and NPSH levels and decreased levels of GSH, GST and CAT in renal tissue extract. On contrary, RSV injection in combination with GEN significantly ameliorated the effects imposed by GEN on the oxidant/antioxidant equilibrium manifested as a non-significant increase of tissue extract levels of MDA and NPSH associated with non-significant decrease of tissue extract level of GSH and GST in GEN+RS V group compared to control group [p[1]>0.05] but tissue extract levels of SOD and CAT were significantly increased [p[1]=0.016 and 0.005, respectively] compared to control group. RSV lessened the nephrotoxic effect of Gentamicin in combination group with a significant decrease of serum urea and creatinine levels compared to that estimated in GEN group, [p[2]=0.008] with a significantly decreased serum Na+ and increased serum K+ compared to levels estimated in GEN group [p[2]=0.007 and =0.008, respectively]. Light microscopic examination of renal tissue obtained from rats injected with GEN for 6 days, showed degenerative changes with necrosis of proximal tubular cells and contracted glomeuli associated with tubular and glomerular vacuolation. There was tissue edema and intense inflammatory cellular infiltrates. Semi-quantitative analysis of tubular necrosis, tubular vacuolization and parietal cell hyperplasia in animals treated by GEN and GEN+RSV showed a significant reduction of scores of each parameter in GEN+RSV group compared to GEN group with no necrosis reported in 55.6% and no parietal cell hyperplasia in 33.3% of animals included in GEN+RSV group, while all GEN treated animals showed tubular necrosis and vacuolation with parietal cell hyperplasia of varied scores. It could be concluded that concomitant administration of resveratrol during Gentamicin therapy in high dose and for long period could ameliorate the structural changes and preserve the oxidant/antioxidant balance in renal tissue with minimization of affection of renal function tests

Prevalence of silent hepatitis B and HCV genotype among chronic hepatitis C patients

This multi-center study was designed as a trial to explore the prevalence of silent hepatitis B infection among hepatitis C patients and to determine the prevalent genotype of hepatitis C virus [HCV] in these patients. The study comprised 45 patients with post-hepatitic liver cirrhosis. All patients gave blood samples for estimation of liver function tests, ELISA estimation of serum levels of hepatitis B surface antigen [HBsAg], anti-HCV antibodies and HCV core antigen, patients with HBsAg positive were excluded off the study. Qualitative detection of HCV RNA and HBV DNA by PCR [home-made PCR] and Quantitative PCR for estimation of HCV viremia and HCV genotyping: by REFLP technique were performed. The HCV-Ab was detected in all and HCV-Ag in 42 samples [93.3%] irrespective of its clinical severity class with a mean viremia level of 792336.7 +/- 400074.8; range: 134985-1957632 viral copy/ml as determined by quantitative PCR. There was a non-significant difference between severity clinical classes as regards the qualitative or quantitative detection of HCV infection. The HBV DNA was detected using qualitative PCR in 20 samples [44.4%]; 4 class A, 7 class B and 9 class C samples with a significant increase of the frequency of silent HB in patients with class B [X[2]=5.446, p<0.01] and C [X[2]=8.154, p<0.001] in comparison to class A patients. Genotyping of HCV reported 41 samples [91.1%] with genotype-4 and 4 samples [8.9%] with genotype-1 with a prevalence rate of HCV genotype-4 was 91.1%. There was positive non-significant correlation between both HCV genotype and the presence of silent hepatitis B infection and clinical severity, however, using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] to evaluate the sensitivity and specificity of detection of silent hepatitis B infection and identification of HCV genotype as predictors of severe hepatitis showed a non-specific role for genotyping for prediction of severity with AUC=0.467, while the detection of HBV DNA using PCR in patients with HCV infection is a specific predictor of severity with AUC=0.617. It could be concluded that HCV genotype-4 is the most prevalent type in Egyptian Hepatitis C cirrhotic patients with a prevalence of silent hepatitis B of 44.4% and its detection is a specific predictor of severe cirrhosis