Relation of ALT and AST levels to the histopathological changes in liver biopsies of patients with chronic hepatitis C genotype 4

Worldwide, Egypt has a high prevalence of adult hepatitis C virus [HCV] infection. Serum alanine aminotransferase [ALT] activity is most commonly measured to assess hepatic disease. The revision of the definition of the normal limits for the ALT level is advisable. The aim of this work was to compare the histopathological changes in the liver tissue biopsies of HCV-infected patients, clinically presenting with ALT levels below normal, based on the conventional, previously used upper limit of normal [ULN] of ALT [40 U/L for men and 30 U/L for women] with the proposed new ULN [30 U/L for men, and 19 U/L for women]. This is a retrospective cross-sectional study. A total of 668 cases of chronic hepatitis C genotype 4 were included. Patients were classified according to grades of histological activity and fibrosis stages [by the Metavir scoring system]. They were also classified into normal and high groups according to the old and new cutoffs of both aspartate transaminase [AST] and ALT levels.The results of our study showed that the serum AST level in our study showed a better correlation with the histopathological changes in liver biopsy rather than ALT, especially when using the old cutoff of the ULN for AST. The serum ALT level in our study [both the old and the new cutoffs] did not show a significant correlation with the histopathological status in the liver biopsies of our patients. This study concluded that the old cutoff of the ULN AST is a better predictor of fibrosis

[Biomonitoring of genotoxicity and antioxidant enzymatic changes in workers occupationally exposed to asphalt fumes]

Asphalt fumes consist of the gases and vapor emitted from the heated asphalt as well as the aerosols and mists resulting from their condensation after volatilization .Moreover, asphalate workers are exposed to variety of asphalted fumes and dusts, which can exert their toxic effects via production of reactive oxygen species. The spectrum of oxidative DMA damage includes strand breaks. Information on genotoxic risk for bitumen workers is limited. The aim of the present study was biomonitoring of genotoxicity and different antioxidant enzymes activity of workers occupationally exposed to asphalted fumes. Method It was conducted on fifty male workers employed in asphalted and proofing materials manufacturing. Fifty subjects were recruited as a control group matched for age, sex and socio-economic status. revealed that high significant association in the levels of genotoxicity [DMA single strand breaks and urinary thioethers] and slightly significant reduction in the levels of antioxidant enzymes [SOD and CAT] and significant increase in GSH levels in exposed workers in comparison with control group. Moreover, level of Sulphur dioxide and Nitrogen dioxide did not exceed the standards Particulate matter which is exceeded the standard limits of indoor air quality. Present data indicate that asphalted fumes exposed workers exhibit an increase in GSH levels and oxidative stress induced by fumes may partly be attributed to the inhibited activities of SOD and CAT as well as increase in the potentials genotoxic risks by increasing the percentage of DNASSB and increase excretion of urinary thioethers

Band ligation versus beta-blockers in the prevention of primary bleeding of oesophageal varices: clinical, biochemical, ultrasongraphic and endoscopic evaluation

Most of the published data comparing endoscopic variceal band ligation [EVL] to propranolol for primary prevention of variceal bleeding have reached a conclusion that EVL is the option for patients with contraindications or intolerance to beta-blockers. Whether it is an alternative to beta-blockers that could be used for all cirrhotic patients with varices in case propranolol fails, or it is the prophylactic treatment of choice has not been answered. This study was designed to compare the effectiveness of prophylactic EVL to propranolol in the primary prevention of variceal bleeding from medium and large sized varices among Egyptian patients. The study included 60 patients with chronic liver disease, grade III or IV varices and negative history of variceal bleeding. Patients were randomized to receive either EVL or propranolol and were followed up every 3 months for one year. In the EVL group, successful initial variceal obliteration was achieved in 22 patients [88%]. In 5 of these patients [22.7%], variceal recurrence to grade II occurred. Failure to reduce the size of varices was reported in one patient [4%]. Patients in the propranolol group showed high incidence of hypotension [52.1%]. The mean dose of propranolol was low [43 +/- 7.3mg]. A resting heart rate of 69 beats/mm was 100% sensitive and 100% specific for the development of hypotension. Both groups were comparable as regards bleeding and overall mortality but compliance to therapy was significantly less in the propranolol group. Adverse effects to therapy were significantly higher in the propranolol group as hypotension occurred in 52.1% of patients. Although EVL is an invasive therapy as compared to propranolol, yet patients are more compliant to this short term therapy. Given this fact in addition to the high incidence of drug intolerability seen with propranolol makes EVL the preferred therapeutic option despite the comparable effectiveness of the two modalities in the primary prevention of variceal bleeding