Study of interlukin-18 in viral hepatitis C patients with chronic hepatitis and hepatocellular carcinoma

Hepatitis C virus [HCV] infection represents a serious threat to human health; often resulting in liver cirrhosis and hepatocellular carcinoma [HCC]. The exact mechanisms responsible for persistent infection and long -term hepatocellular injury are poorly understood. It is hypothesized that the pro-inflammatory cytokine IL-18 may have an important role in chronic cellular immune response towards hepatocytes in the course of the disease. Of this study was to evaluate the significance of measuring IL-18 mRNA in peripheral blood mononuclear cells [PBMCs] in viral hepatitis C patients with chronic infection and HCC. Forty selected patients with chronic HCV infection [12 with compensated liver functions "group I" ; 12 with decompensated liver functions "group II"; and 16 with HCC on top of chronic HCV infection "group III"] and 10 healthy controls with matched ages and sex were studied. Using reverse- transcriptase polymerase chain reaction [RT-PCR], detection of HCVRNA in blood of patients and quantitation of IL-18 mRNA transcripts in PBMCs of patients and control were performed. This study showed a significant increase [p<0.001] in the mean value of transcriptional expression of IL-18 gene [as a ratio to that of beta-globin] in PBMCs in all patients groups compared to control. A positive [however insignificant] correlation was detected between transcriptional expression of IL-18 gene and serum albumin [r=0.446]; ALT[r=0.074] as well as prothrombin time [r=0.332] in chronic viral hepatitis patient groups [compensated and decompensated]. A significant positive correlation was found between transcriptional expression of IL-18 gene and hepatitis C viral load in all patient groups[r=0.756; 0.669; and 0.956 respectively]. These results support the hypothesis that IL-18 has an important role in the immunopathogenetic events leading to liver injury in chronic HCV infection. The antiviral action of IL-18 might be counteracted by multiple factors leading to persistent HCV infection [as IL-10]. The question becomes important whether and to what extent the HCC is influenced by IL-18. Future follow- up studies are recommended to investigate the role of monoclonal antibody to IL-18 in amelioration of liver damage and cirrhosis in such patients, in addition to further studies to highlight the role of IL-18 binding protein [BP] and Th-2 cytokines [as IL-10] as possible antagonists to the antiviral action of IL-18. Finally future- large scales studies correlating IL-18 gene expression with markers of HCC progression are recommended to gain insight into the antitumor action of IL-18 as it would be a promising new strategy to control HCC

Molecular detection of methicillin resistant "mecA" gene in coagulase negative staphylococci causing bacteremia

CoNS and specifically, the dominant species Staph epidermidis have emerged in recent years as pathogens of serious nosocomial infections in neonatal intensive care. Methicillin resistant strains are particularly important because they show narrow therapeutic options. Detection of methicillin resistance among CoNS is often difficult, because these microorganisms present a hetero-resistant pattern. This work aimed to isolate the aerobic and facultative anaerobic organisms causing bacteremia in PICU of Ain Shams University hospital, assess the antibiotic-sensitivity for these organisms and to study the molecular detection of methicillin resistant "mecA" gene in CoNS in comparison with the phenotypic disk diffusion method. The study included 100 patients admitted to the PICU, from March 2003 to August 2003, for whom blood cultures were performed. Bacterial isolates including CoNS isolates were subjected to antibiotic sensitivity testing and PCR for detection of mecA gene. This study showed that 42% of patients had positive blood culture. Gram-positive organisms accounted for 47.7% of cases of which 42.9% were CoNS. Gram-negative organisms represented 38.1% and Candida spp accounted for 14.2%. The antibiotic sensitivity for CoNS isolates ranged from 22.2% [for both oxacillin and methicillin] to 66.7% [ampicillin + sulbactam]. Out of the 18 CoNS isolates, 11 isolates were mecA positive while the rest 7 isolates were mecA negative. Comparing the PCR with disk diffusion results showed that from 11 mecA positive isolates, 9 isolates were detected by disk diffusion as methicillin resistant [MR] and this include only Staph. epidermidis isolates. The other two mecA positive isolates were found to be methicillin sensitive [MS] by disk diffusion. From the 7 mecA negative isolates, 2 isolates were MS by disk diffusion. CoNS were the main blood stream infection [BSI] pathogen in Ain Shams University hospital PICU. MRCoNS were resistant to many antibiotics used. Disk diffusion test was significantly correlated with the PCR in case of Staph epidermidis but PCR was more rapid method for detection of MRCoNS

Incidence of nasal carriers of staphylococcus aureus in and outside hospital environment and antibiotic sensitivity of isolated staphylococcus strains

This study was carried out on 100 nasal swabs collected from medical personnel [nurses and doctors] and patients inside hospital environment and also from 50 individuals outside hospital. The swabs were inoculated on different culture media for isolation of staphylococci which were further identified as S. aureus either by classic bacteriologic methods or by one of rapid screening test of S. aureus. The isolated strains were tested for antibiotic sensitivity to some of B-Lactam antibiotics and to other antibiotics. The results showed that significantly higher percentage of coagulase + ve Staph. were isolated from newborn nursery [90%], operating theatre [71.4%] and hemodialysis unit [60%] than those isolated from intensive care unit, cancer chemotherapy, surgery, chest, internal medicine departments [25%, 26.6%, 31.2%, 33.3%, 50%] respectively. It also showed significant difference in isolation rate between persons at the hospital [patients, doctors and nurses] 44% and controls [normal population] 26%. Most isolates of coagulase + ve Staph. were resistant to penicillin G [93.2%], Streptomycin [77.3%], tetracyclin [61.4%] and sensitive to cefamandole [95.4%]. All coagulase + vs Staph. isolates were resistant to sulphonamide and methicillin and all sensitive to vancomycin