Assessment of the relation between serum-ascites albumin concentration gradient with esophageal varices and its complication

We aimed to evaluate the correlation between serumascites albumin concentration gradient [SAAG] with esophageal varices [EV] presence and grading, and to assess the relationship between SAAG measurements and the occurrence of gastrointestinal hemorrhage in cirrhotic patients with ascites. Our study included 45 nonalcoholic cirrhotic cases with ascites. They had routine clinical, ultrasonographic and laboratory investigations including ascitic fluid analysis. They had measurement of SAAG computed. An upper gastrointestinal endoscopy was done in all cases to assess the presence and size of EV. 36 of our patients [80%] had EV. The mean SAAG level was 1.46 +/- 0.27 gm/dL for all cases. No correlation was found between SAAG and any of the studied clinical or biochemical parameters. By using the ROC Curve, a SAAG value at a level of [>1.55gm/dL], was a good predictor of the presence of EV with 100% sensitivity and 71.4% specificity. The presence of EV was positively correlated with serum bilirubin, prothrombin time [PT], and spleen size. Meanwhile, it was negatively correlated with serum albumin, serum total protein, platelet count and total protein in ascetic fluid. On univariate analysis of variants associated with the presence of large esophageal varices, only the presence of splenomegaly could predict high grade varices. On comparing patients with and without bleeding varices, the EV grade, portal vein diameter [PVD], spleen size and creatinine level were significantly higher in the group of bleeding varices [p values were 0.002, 0.006, 0.01 and 0.012 respectively] A SAAG score [>/=1.55 gm/dL] is a useful predictor of the presence of EV in cirrhotic patients with ascites. This finding can assist clinicians in determining the urgency of care and referral for upper gastrointestinal endoscopy in cases with ascites. Meanwhile, SAAG was not valuable in screening and predicting complications, such as bleeding from esophageal varices

Immunogenicity of hepatitis B vaccine in term and preterm infants

The study was conducted on 60 infants born to hepatitis B surface antigen [HBsAg] negative mothers. Their gestational age ranged from 32 to 40 weeks [36 +/- 2.8] and their birth weight ranged from 1250 to 3800 gm [X2345 +/- 885]. Assessment of the seroprotection of these infants after hepatitis B virus [HBV] vaccination [at 2, 4 and 6 months of age] and its relation to prematurity, birth weight and medical problems as respiratory distress syndrome [RDS], blood transfusion, steriod treatment and sepsis, on seroconversion was done, anti-HBs antibody levels were measured one month after the third dose of vaccine [at 7 months of age]. Hepatitis B seroprotection could be obtained in 100% of infants with birth weight of 1500 gm or more. Very low birth weight [VLBW] infants [< 1500 gm] seroprotection was 3 7.5% which is unacceptably high due to severe immaturity of the immune system. Lower gestational age, sepsis, respiratory distress syndrome [RDS], treatment with steroids or infants who had a history of blood transfusion were associated with poor seroprotection rates [33.32%, 33.3%, 66.7%, 66.6% and 66.7% respectively]. It may be concluded that, premature infants of birth weight < 1500 gm, and who suffered from RDS, sepsis, received blood transfusion or had been treated with steroids, their anti-HBs antibody level must be checked after the age of 7 months to decide if they are in need of a booster dose of HBV vaccine or not

Helicosacter pylori and chlamydia pneumonial in coronary heart diseases

The effect of infection by Chlamydia pneumoniae [C. pneumoniae] and Helicobacter pylori [H pylori] on patients with coronary heart diseases [CHD] was investigated. 40 patients: 20 suffered from acute myocardial infarction [AMI] [Group I] and 20 suffered from angina [Group II] were selected as patient groups. 20 clinically healthy persons of the same age were selected as acontrol group [Group III] - The patient groups were sub-grouped according to the most important risk factors for CHD [smoking, hypertension, and hypercholesterolaemia]. The level of C.pneurnoniae IgG and IgM and H.pylori IgG were detected in the sera of the three groups. It was found that C.pneumoniae IgG was positive in 18%, 14%, and 4% with mean titre 364. 8, 380.7, 12.8 [in groups I, II, and III respectively] which was significantly higher in group I and II than group IlI C.pneumoniae IgM was negative in groups I and III, while it was positive in 15% of group II with mean the 275.6 with a statistical significance among the three groups. H.pylori IgG was positive in 60%. 50%, and 45% with mean concentration 312.2, 315.4, and 151.3 on groups I, II, and III [respectively] with insignificant difference among the three groups. As regards to smoking status, C.pneumoniae IgG was higher in smokers than in non-smokers in groups I and II with significant difference in group I only. C.pneumoniae IgM was insignificant in both groups. H.pyloni IgG was high in smokers in both groups with non significant difference. Concerning blood pressure, C.pneumoniae IgG, IgM and H.pylori IgG in both groups were high in hypertensives with no significant relation amoung them. As regards to cholesterol level, the mean titres of C.pneumoniae IgG and IgM were high in hypercholesterolaemic patients in both groups with no significant relation among them, while the mean concentration of H.pylori IgG was high in hypercholesterolaemics in both groups with a significant difference in group I only. We concluded that, infection with C. pneumoniae and to leeser extent H. pylori may play a role in the pathogenesis of CHD and their treatment may enhance the recovery of the disease