Does isoflurane anesthesia alter immuno-modulatory response in schistosomal Patients?. Assessment of serum pro- and anti-inflammatory cytokine balance

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immuno-suppressive effects, can influence long term disease progression, morbidity, and mortality. Literature on postoperative immune response in schistosomiasis patients is scarce. The aim of this study was to assess the impact of isoflurane anesthesia on pro- and anti-inflammatory cytokine balance in schistosomal patients undergoing minor procedures. The study was conducted on 24 patients [ASA class I-II] scheduled for elective urologic endoscopic procedures. Patients were divided into two groups 12 patients each: control group [n=l2] and patient group [n=l2]. Anaesthesia was induced by a bolus dose of sufentanil 0.2 micro g.kg -1, thiopentone sodium 5mg.kg -1, vecuronium 0.1 mg.kg -1 and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 micro g.kg -1 when indicated. Venous blood samples were obtained from each patient: before induction, fifteen minutes, one hr after induction and 24 hrs after surgery. Plasma levels of IL-1 beta, TNF-alpha, IL-8, IFN-lambda, IL-1ra and TNF-BP1, as well as stress hormones [cortisol and prolactin] were measured. As for pro- and anti-inflammatory cytokine balance, the overall end- result was a rise at 24 hr postoperatively, in the level of TNF-alpha [a key pro-inflammatory cytokine] and IFN-lambda, as well as both anti-inflammatory cytokines [IL-Ira and sTNF-R1]. The anti-inflammatory response was more conspicuous in the patients than controls

Proactive measures in family practice: the approach and limitations in a chronic disease model

Chronic diseases form an important health problem facing the health system in Egypt. The family health model provides an integral approach to health problems including chronic diseases to provide the basic services which include both health and population interventions. The aim of this work was to improve the health of the Egyptian population and to decrease the burden of chronic illness. Specific objectives were to assess the present and potential role of family practice in prevention and control of priority chronic diseases and to develop a prototype for family practice services dealing with these diseases. The study was conducted in one of family health units, Kafr Ayoub rural health unit Belbeis district, Sharkeya governorate. The methodology followed a Systems Analysis [SA] approach. In addition an exit interview questionnaire was done with clients for assessment of satisfaction and orientation about family practice. Hypertension was the selected model of chronic diseases in this study. Results of basic clinical examination done by the Ministry of Health and Population health team was compared to the results of clinical examination done by the research team to assess the quality of initial examination. Cases of Diabetes Mellitus were similar whereas diagnosed cases of hypertension showed variation. A protocol for diagnosis and follow up was suggested and implemented in this unit during the study period. Health education messages were prepared by the study team. Health care providers were trained to implement health education sessions for clients and hypertensive patient as a starting model for health education within the family practice program. The main recommendation is to increase awareness about family practice and the importance of the family physician in detecting and follow up of chronic disease being the first gait to the health system in the country. The importance of cooperation between MOHP and the university was emphasized

influence of isofluorane anesthesia on the balance between serum pro- and anti-inflammatory cytokines

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immunosuppressive effects, can influence longterm disease progression, morbidity, and mortality. The effects of surgery, surgical stress, and anesthesia compromise the optimal function of the immune system. The purpose of this study was to clarify the effect of isofluorane anesthesia on the balance between serum pro- and anti-inflammatory cytokines in schistosomal patients undergoing minor endoscopic urological procedures. Our study was conducted on 24 patients [ASA class I-II] scheduled for elective urologic endoscopic procedures of more than one-hour duration. Patients were divided into two groups control group [n=12] and schistosomal group [n=12]. Anaesthesia was induced in by a bolus dose of sufentanil 0.2 microg.kg[-1], thiopentone sodium 5mg.kg[-1], vecuronium 0.1 mg.kg-1 and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 microg.kg-l. Four venous blood samples were obtained from each patient: Before induction, 15 minutes after induction and before start of surgical procedure, at the end of anesthesia and surgery and 24 hour after operation. Scrum pro-inflammatory cytokines: tumor necrosis factor alpha [TNF alpha], interleukin-lbeta [IL-lbeta], interferon gamma [IFN-y], and interleukin-8 [IL-8] and serum anti-inflammatory cytokines: interleukin-1-receptor antagonist [IL-Ira] and soluble tumor necrosis factor receptor-1 [sTNF-RI]; as well as stress hormones [cortisol and prolactin] were measured by ELISA. As for pro- and anti-inflammatory cytokine balance in our study, the overall end-result in both groups was a rise at 24 hours postoperatively, in the level of the pro-inflammatory cytokine TNF-alpha and both anti-inflammatory cytokines investigated IL-Ira and sTNF-RI. The rise of the anti-inflammatory cytokines was more conspicuous in the schistosomal than non-schistosomal patients. In conclusion, we suggest that inhalational anesthesia using isoflurane, offers a minimal proinflammatory harmful response with a good postoperative antiinflammatory one especially in schistosomal patients, thus fulfilling the ultimate goal of proposing strategies for better patient outcome

Assessment of the clinical significance of serum vascular endothelial growth factor and matrix metalloproteinase-9in patients with hepatrcellular carcinoma

The pre-therapeutic serum levels of VEGF and MMP-9 were studied in patients with HCC, cirrhotic patients and in healthy subjects by an ELISA assay to elucidate the relationship between serum VEGF, MMP-9 levels and clinicopathological characteristics of HCC. The serum VEGF and MMP-9 were significantly elevated in HCC patients with macroscopic portal vein invasion and with metastasis as compared to HCC patients with neither invasion nor metastasis. Serum VEGF showed a significant difference between HCC patients with tumor size > 5 cm and < 5 cm, however serum MMP-9 did not vary with tumor size. It was concluded that the portal vein invasion and metastasis in HCC is a complex process involving multiple factors including VEGF-mediated angiogenesis and MMP-9 induced degradation of extracellular matrix. The pre-therapeutic serum VEGF and MMP-9 in HCC might be candidate biomarkers reflecting the disease potential for vascular invasion and metastasis, serum VEGF being a superior biomarker as it correlated also with tumor size