Selective intestinal decontamination in patients with schistosomal hepatic fibrosis and low-protein ascites

Selective intestinal decontamination [SID] for 7 days with norfloxacin [NF] was performed in 15 patients with schistosomal hepatic. fibrosis [SHF] and low-protein ascites. Changes in ascitic fluid [AF] opsonic activity and complement3 [C3], complement4 [C4], total protein [TP] and albumin concentrations after NF therapy were compared with those of a control group composed of 15 untreated patients with similar characteristics. After oral NF administration, the mean% changes of AF opsonic activity and AF C3 and TP concentrations showed significant increases and were significantly higher than those in the control group .There were direct correlations between mean% changes in AF opsonic activity and C3 concentrations [r= 0.62]. AF Opsonic activity and TP concentrations [r = 0.54] and AF C3 and TP concentrations [r = 0.57] in the NF group. On the other hand, the AF C4 and albumin concentrations were not significantly changed In any group at the end of the study.Based on the results of the present study, it can be concluded that short-term NF therapy in patients with SHF and low-protein ascites increased AF opsonic activity and AF C3 and TP concentrations and hence, AF bactericidal activity.Study of larger numbers of patients for longer periods will determine if these beneficial effects on NF translate into a decreased incidence of spontaneous bacterial peritonitis in patients with chronic liver disease and high-risk of infection

Schistosomal nephropathy: effect of cyclosporine A [Csa] in murine schistosomiasis mansoni

The effect of ciclosporin A [CsA] on schistosomal nephropathy in infected mice with Schistosomal mansoni [S. Mansonj] has been investigated. Infected mice were orally treated with 50 mg/kg body weight of CsA for 5 consecutive days at the 8[th], 12[th], 16[th] week postinfection [p.i.]. Four weeks after drug therapy, CsA aborted and retarded the progression of glomerular injury in all stages of the disease; particularly with early drug therapy. This was evidenced by the reduction in electron dense deposits and weak positivity by fluorescent microscope. This response was accompanied by amelioration of hepatosplenomegaly. The effects of CsA could be related to its known immunosuppressive effect on T-helper [Th] cells. Moreover, CsA had a profound anti-schistosomal activity as demonstrated by the significant decrease in worm burden specially female worms, and the increase in the percentage of mature and dead eggs in intestinal mucosa in this study. So, CsA would ameliorate the glomerular lesion in early stages of schistosomal nephropathy, mainly by its immunosuppressive effect, but in later stages, the direct anti-schistosomicidal effect would take the upper hand

Renal acidification in patients with insulin dependent diabetes mellitus

Twenty patients with insulin dependent diabetes mellitus [IDDM] and ten control persons were studied. The diabetic patients were further subdivided into two subgroups [microalbuminuric and the normoalbuminuric subgroups]. In both groups, the arterial blood gases and pH showed insignificant change after a short ammonium chloride load, while there was a significant decrease in plasma bicarbonate. Urinary acidification tests showed significant increase in urinary ammonium [UNH4], titrable acid [UTA], net acid excretion [UNAE], pH, bicarbonate [UHCO3] and fractional bicarbonate excretion percentage [FHCO3%] after the test load. The increase in UNH4 in diabetics was less than the controls. The basal UHCO3 and FHCO3 percentage in diabetics was higher than the controls, while the FHCO3 percentage was less than 10%, which excluded the proximal tubular defects. Urinary acidification tests showed no difference between the microalbuminuric and the normoalbuminuric diabetics. UNH4 seems to play a major role in urinary acidification in the normoalbuminuric patients, this was shown by the negative correlation between the urinary pH and UNH4 before and after the test in these patients. So, tubular acidification mechanism is affected in patients with IDDM and this tubular dysfunction is mainly due to a distal tubular defect and it may occur earlier in the disease before the appearance of microalbuminuria as a glomerular marker

Plasma and pleural effusion fibronectin in malignant and non-malignant effusion

Thirty patients with pleural effusions; 15 with malignant effusion and 15 with nonmalignant effusion were studied. Liver function tests were normal in both groups of patients. Pleural fluid total white count, lymphocytes and polymorphonuclear cells were significantly higher in nonmalignant than malignant groups, while pleural fluid protein content in malignant group was more often in the range of concentrations found in nonmalignant group. This showed that the rise in protein content of pleural fluid is not specific and can not discriminate malignant form nonmalignant pleural effusion. Fibronectin [FN] and cholesterol contents in malignant pleural effusion were significantly higher than nonmalignant pleural effusion. Also, pleural fluid FN in malignant group was higher than its serum level. No correlation was found between the pleural fluid FN and its serum level in both groups which shows that pleural fluid FN is not only due to simple exudation from plasma, and it may be in part produced locally. No correlation was found between pleural effusion FN and cholesterol and the protein content in both groups of patients. A good positive correlation was found between pleural effusion FN and cholesterol content in malignant group. So, this work showed that the measurement of pleural effusion FN offers a good discrimination and a higher differential diagnostic efficiency for malignant effusion superior to the conventional protein determination

Oxidative metabolism of phacocystic cells and interleukin-I [IL-I] production by monocytes in patients on maintenance hemodialysis

Fifteen patients with chronic renal failure [CRF] on maintenance hemodialysis [HD] and 15 healthy subjects as controls, were studied for the respiratory burst activity of both polymorphonuclear cells [PMNC] and monocytes by measuring the chemiluminescence [CL] after stimulation by zymosan and the superoxide anion after stimulation with phorbol myristate acetate [PMA], respectively. Also, monocyte capacity to synthesize and release of interleukin-1 after stimulation by lipopolysaccharides [LPS] was investigated. CL activity by PMNC was significantly higher, while the superoxide anion generation by monocytes was significantly lower in patients on HD than the controls. IL-1 release by monocytes was significantly lower in patients when compared to the controls. So, this study showed that monocytes of patients with CRF on HD have depressed functions as regards the phagocytic activity and the capacity to synthesize and release the monokine IL-1. Also, the PMNC showed an increase in the generation of reactive oxygen metabolites. These could contribute to the enhanced susceptibility to infection and to some of the acute and long term complications observed in these patients

Study of some respiratory physiological parameters in patients with chronic renal failure during hemodialysis

Twenty non smoker patients with chronic renal failure on maintenance hemodialysis were studied. Forced vital capacity [FVC] and peak expiratory flow [PEF] decreased significantly after 30 minutes from the start of dialysis followed by insidious increase to levels close to predialysis values at the end of dialysis. Maximal expiratory pressure [PE max] did not show any significant change throughout the dialysis. Serum bicarbonate, base excess and arterial pH increased throughout the dialysis specially after 60 minutes from the start of dialysis till its end. Arterial PCO2 showed minimal changes. However, there was a significant increase after 30 minutes as well as throughout the dialysis. The possible roles of uremic pulmonary edema, peribronchial edema, release of bronchoconstrictor mediators secondary to bioincompatibility of the dialyser membrane, uremic myopathy as well as the possible role of hypoventilation occurring as a compensation for CO2 loss through the dialyser were discussed in explanation for the previously mentioned results