Clinical relevance of cryoglobulinaemia and extrahepatic neurocutaneous manifestations of chronic hepatitis C

The association of hepatitis C virus [HCV] with the extrahepatic complications of cryoglobulinaemia is widely recognized. The aim of this research was to examine the prevalence of cryoglobulinaemia [Cg] in patients with chronic HCV infection and its relation to extrahepatic neuro-cutaneous manifestations. Forty patients [26 males and 14 females], with clinical, laboratory and histopathologically established chronic HCV, with a mean age of 37.5years were submitted to clinical examination with stress on stigmata of chronic liver disease, dermatological and neurological evaluation as well as neurophysiological evaluation, laboratory assessment including liver function tests, serum cryoprecipitate immunoelectrophoresis, and revision of histopathlogical findings. a high prevalence of Cg: 62.5% in patients with chronic HCV infection, the presenting symptoms were fatigue [67.5%], artheralgia [32.5%], parathesia [30%] and pruritus [25%], however, there were no statistically significant difference between cryo +ve versus Cryo -ve patients except for pruritis, face pigmentation. Skin manifestations inclding face pigmentation [42.5%], leukocytoclastic vosculitis [LCV] [22.5%], Porphyria cutanea tarda [PCT] [20%], Lichen planus [17.5%], acral necrolytic erythema [15%] and vitiligo [15%]. Neurological manifestations including symptomatic neuropathy in 10%, neuropathic changes detected by nerve conduction velocity [NCV] and electromyography [EMG] in 30% and electroencephalographic changes in 22.5%. Interestingly, these cutaneous and neurological manifestations were significantly associated with the presence of cryoglobulinaemia. Liver histopathology of the studied patients according to METAVIR score [Activity] A0-3 [Fibrosis] F0-4 showed no statistically significant difference between cryo positive versus cryo negative patients. conclusion findings confirmed a clear association between cryoglobulianemia and extrahepatic neurocutaneous manifestations of HCV infection. The presence of these manifestations in the appropriate clinical setting should suggest the presence of HCV infection

Clinical relevance of cryoglobulinaemia and extrahepatic neurocutaneous manifestations of chronic hepatitis C

To examine the prevalence of cryoglobulinaemia in patients with chronic hepatitis C infection and its relation to extrahepatic neuro-cutaneous manifestations. Forty patients [26 males and 14 females], with clinical, laboratory and histologically established chronic hepatitis C infection, with a mean age of 37.5 years, were submitted to clinical examination, dermatological and neurological evaluation. Neuroimaging as well as neurophysiological evaluation, laboratory assessment including liver function tests, serum cryoprecipitate immunoelectrophoresis, and revision of histopathlogical findings were performed. A high prevalence of cryglobulenemia: 62.5% in patients with chronic hepatitis C infection, the presenting symptoms were fatigue [67.5%], arthralgia [32.5%], paresthesia [30%] and pruritus [25%]; however, there were no statistically significant difference between cryo + ve versus cryo - ve patients except for pruritis, and face pigmentation. Skin manifestations including face pigmentation [42.5%], leukocytoclastic vasculitis [22.5%], porphyria cutanea tarda [20%], lichen planus [17.5%], acral necrolytic erythema [15%] and vitiligo [15%]. Neurological manifestations; symptomatic neuropathy in 10%, neuropathic changes in 30% and electroencephalographic changes in 22.5%. These cutaneous and neurological manifestations were significantly associated with the presence of cryoglobulinaemia. Our findings support an association between cryoglobuliaemia and extrahepatic neurocutaneous manifestations of hepatitis C infection. The presence of all these manifestations in the appropriate clinical setting should suggest the presence of hepatitis C infection

Immunhistochemical identification of HCV target antigen in paraffin embedded liver tissue using the Tar DJI-22 monoclonal antibody: reproduciblity and staining patterns

Many of anti-HCV antibody-positive patients who are seronegative for HCV RNA were found positive by RT-PCR within the liver biopsy. In situ PCR, while sensitive, is technically difficult and expensive. So, there is a need for a simple, specific and reproducible method to identify HCV target antigens in liver biopsy specimens, which will help in more accurate diagnosis. Immunohistochemical staining has been applied successfully to detect HCV antigen in fresh frozen tissue. In paraffin-embedded tissues, however, minimal trials with conflicting results have been reported. The present study is a trial to evaluate the identification of HCV antigen in paraffin embedded liver biopsies using the anti HCV monoclonal antibody TORDJI-22 and to correlate the results with clinical and histopathological severity in chronic hepatitis C patients. Methods: We applied immunohistochemicl staining for HCV in 66 paraffin-embedded liver biopsy specimens. 46 from patients seropositive for HCV -RNA and twenty control liver biopsy specimens [5 HBV patients and negative for HCV, 5 metabolic liver diseases, 5 auto-immune chronic hepatitis and 5 extrahepatic biliary atresia]. The TORDJI-22 monoclonal antibody was applied in dilution 1:40, with overnight incubation. HBsAg and HBcAg immunohistochemistry were applied routinely. Results: Reproducible staining patterns of HCV antigen in tissues were identified among the majority [.42/46 - 91%] of HCV RNA seropositive cases. The staining pattern was cytoplasmic of hepatocytes, with occasional nuclear hue. It is mainly coarse granular with microvesicular pattern. Three staining patterns were identified: A diffuse or membranous, B; patchy, and C;occasional paranuclear.Non of the control samples showed a similar staining pattern. Conclusion: Immunohistochemical identification of HCV antigen is easy to apply in paraffin embedded liver biopsy specimens when the optimal detection techniques were applied. HCV target proteins in liver tissues could be markers of progressive damage. Also, accumulation of these proteins may be involved in the pathogenesis of hepatocyte injury in chronic hepatitis C

Helicobacter pylori: does it play a role in pathogenesis of acute appendicitis

The exact aetiology of acute appendicitis remains uncertain but an infective origin has been proposed. It was postulated that helicobacter pylori infection could cause mucosa associated lymphoid tissue hypertrophy in the appendix to the extent that under certain conditions luminal obstruction and acute appendicitis might occur. This study was done to confirm whether helicobacter pylori forms part of the microenvironment of the appendix and whether it play a role in the pathogenesis of acute appendicitis. This study was performed on 62 patients with acute appendicitis ranging in age from 8 to 42 years. There were 39 females and 23 males. All patients subjected to open appendicectomy, fresh specimens from the appendix was taken and cultured on blood agar and subjected to urease test. Other specimens was subjected to histopathological examination. Pathological grading of the appendicitis was performed according to the depth of inflammatory infiltrate. 10 ml of blood was drawn from all patients for serological assessment of helicobacter pylori. Fifty patients had a pathological appendix [80.6%] with different grades of inflammation. The appendix was histologically normal in 12 patients [19.3%]. Forty-two cases [67.7%] were sero negative in whom the appendix was inflamed in 33 cases [78.6%]. Twenty cases [32.3%] were seropositive in whom the appendix was inflamed in 1 7 cases [85%]. Multiple organisms were grown on all plates and 7 biopsies were positive for urease activity. There was no evidence of helicobacter pylori in any sample on histological examination. We have concluded that helicobater pylori does not colonize the appendix and is unlikely to be a pathogenic stimulus for appendicitis. However, downstream effect of gastroduodenal infestation might induce immunological effect