Effect of growth hormone in the management of short bowel syndrome in neonates

Management of short bowel syndrome is a challenge in the postoperative period due to defect in the absorptive surface area which leads to diarrhea with loss of a large amount of fluids and nutrients that necessitates specific enteral and parenteral nutrition. These manifestations improve when the process of intestinal adaptation starts. There is a controversy about the role of growth hormone in accelerating the process of intestinal adaptation. In this study, 24 patients with short bowel syndrome were divided into two groups. The first group consists of 14 patients received growth hormone and a second group consists of 10 patients that didn't receive growth hormone. In both groups, enteral and parenteral nutrition, loperamide to delay intestinal motility and ranitidine in the first week to decrease gastric hypersecretion were given. The beginning of intestinal adaptation beside histological examination of the intestine was compared in both groups. Growth hormone appeared to have a positive effect on accelerating the intestinal adaptation in short bowel syndrome clinically. The histological examination which was done 3-6 months postoperatively revealed increase of the length of the villi with thickened mucosa in both groups without significant difference because, most probably, the histological study was done after the intestinal adaptation has started in both groups

Decreased Helicobacter pylori-associated gastric epithelial proliferation by concurrent Schistosomal infection

Helicobacter pylori [H. pylori] injection is associated with increased gastric epithelial proliferation, the enhanced epithelial proliferation is important in developing gastric carcinoma. Some developing countries with a high prevalence of H. pylori infection have high gastric cancer rates, whereas in others, these rates are low. The progression of helicobacter-induced gastritis and gastric atrophy mediated by T-helper cell, type 1 [Th1] response may be modulated by concurrent parasitic infection. Pathogenic helminths of the genus Schistosoma cause T-helper cell, type 2 [Th2] response to parasite eggs. The Th2 response is usually associated with down regulation of Th1 cytokine synthesis. The aim of the present study was to assess whether concurrent Schistosoma mansoni infection with H. pylori has an effect on gastric mucosal injury in view of cell proliferation, apoptosis, pathological changes, nitric oxide and oxyradicals status. Between April 2001 and March 2002, 73 patients [13 child and 60 adults] were subjected to upper gastrointestinal endoscopy for dyspepsia and liver cirrhosis in the National Liver Institute, Menoufiya University. Four biopsy specimens were taken, two from the greater curvature of the antrum and two from the upper body of the stomach, biopsies were obtained from any lesion as well as from apparently healthy mucosa. One snap from each site was preserved in RNA later solution, then kept at -80°C till utilized for estimation of DNA-flow cytometric assay, reduced glutathion [GSH], catalase [CAT], superoxide dismutase [SOD], Nitric oxide [NO], and lipid peroxidation product- malondialdehyde [MDA]-. Diagnosis of bilharziasis was done by stool analysis, or by sigmoidoscopy and rectal snip. OF the 73 patients, 60 patients were cirrhotic [20 Child A, 34 B, 6 C], 48 were H. pylori-positive and 25 H. pylori negative. The mean age in H. pylori positive patients [46.31 +/- 10.7 years] was significantly less than in H. pylori - negative patients [52.8 +/- 7.2 years]. Infection with H. pylori alone correlated with increased DNA s-phase, proliferation activity and apoptosis [sub-G phase] [p 0.04, 0.03 and 0.04] respectively. Concurrent infection with schistosomiasis occurred in 34 patients and it significantly suppressed DNA 5-phase [P=0.001], proliferation activity [p<0.004], and apoptosis [sub-G phase], [p>0.05]. On contrast, concurrent infection had an adverse effect on liver cirrhosis with increased incidence of upper gastrointestinal bleeding. Schistosomal concurrent infection with H. pylori is associated with higher incidence of superficial gastritis, and may complicate liver cirrhosis with increased upper gastrointestinal bleeding. On the other hand, concurrent schistosomal infection may have a protective effect against the possible progression of H. pylori induced gastritis towards gastric carcinoma, by modulating the cytokine profile of the gastric mucosa with suppression of the proliferation activity. A detailed study of the cytokine expression in similar cases is recommended for unraveling the mystery of this phenomenon

Matrix metalloproteinase-9 [Mmp-9] circulating intercellular adhesion molecule-1 [Cicam-1], and procollagen III peptide [PIIIP] in hepatocellular carcinoma and various chronic liver diseases

A sound predictive test is lacking for the identification of cirrhotic patients at high risk of developing hepatocellular carcinoma. In the present study, plasma MMP-9, plasma clCAM-1, serum alpha-feto protein [AFP] and serum PIIIP levels were measured and evaluated in 30 patients suffered from chronic hepatitis [CH], 30 patients suffered from liver cirrhosis [LC] and 30 patients suffered from hepatocellular carcinoma [HCC], in addition to 30 normal healthy individuals as a control group using RIA method for estimation of PIIIP and ELISA methods for estimations of the AFP and clCAM-1 and MMP-9. The study showed that the mean values of plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP levels were 44.8 ng/ml, 232.1 ng/ml, 3.4 ug/l, 3.2 ng/Ml respectively among control group, 88.61 ng/ml, 489.5 ng/ml, 11.5 ug/l, 8.7 ng/ml respectively among Chronic hepatitis patients, 96.6 ng/ml, 781.3 ng/ml, 13.9 ug/l, 26.5 ng/ml respectively among Liver cirrhosis patients and 212.1 ng/ml, 999.4 ng/ml, 26.6 ug/l, 784.6 ng/ml respectively among HCC patients. Plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP showed statistically highly significantly increase in all patients groups [P <0.001] when compared with the healthy control group. Plasma MMP-9 showed statistically highly significant increase in HCC group when compared with CH and LC groups, while did not show any statistically significant change [P> 0.05] in CH and LC groups when compared with the control group or with each other. clCAM-1 showed statistically highly significant increase in LC and HCC groups when compared with CH group with no significant change between LC and HCC groups and lastly serum AFP and PIIIP levels showed statistically highly significantly increase in HCC group when compared with CH and LC groups. As regard HCC histopathological grading all measured parameters showed statistically nonsignificant changes in different HCC grades except MMP-9 which showed a statistically significant increase in grade III when either compared with grade I or grade II. Receiver operating characterstic curve [ROC curve] was constructed using multiple cut off points for every studied parameter and calculating the sensitivity and the specificity at each cut off point and also calculating the area under each curve. The optimum cut off point for diagnosis of HCC from CH and LC for plasma MMP-9, plasma clCAM-1, serum PIIIP, and serum AFP were 89.8 ng/ml, 905 ng/ml, 25.8 ug/L and 68 ng/ml respectively, also, the study showed that AFP was the best of the studied HCC markers as it had the biggest area under ROC curve [0.86] followed by MMP-9 [0.76], cICAM [0.715] and lastly PIIIP [0.71]

Health care quality and impact on: radiologists in Menoufiya hospitals

This Study aimed to assess the protective measures done for prevention of health hazards of ionizing radiation in Menoufiya hospitals. This was achieved through assessment of the environmental safety, performance of radiologists and also through assessment of the health hazards among exposed subjects. All occupationally X-ray exposed workers [l05 males and 37 females] were matched with an equal number of controls, the exposed workers were subdivided into two subgroups according to locality. This study revealed that: although the studied work place environment was considered safe as regards the level of exposure to ionizing radiation [88.7 +/- 20 mrem / year, which is less than MPDE limit] and consequently acceptable structural protective aspects design especially in group I hospitals, but the prevalence of health hazards including behavioral [69.7%], reproductive [21%], skin [25%], cataract [19%] and hematological [33%] abnormalities were significantly higher than controls, also the prevalence of reproductive, skin and hematological disorders were significantly higher among group II workers than group I which could be attributed to bad performance of the radiologists especially in group II workers. Performance of radiologists with negligence of radiation protection measures is considered the most important defect which has its bad impact on health of radiologists in Menoufiya, hence efforts should be directed towards establishment of radiation protection program in hospitals