Study of cryoglobulinemia in patients with chronic hepatitis C viral infection

Hepatitis C virus [HCV] is involved in an increasing number of non hepatic diseases. Mixed cryoglobulinemia [MC] is considered a lymphoproliferative disorder. It is characterized by arthralgia, generalized weakness, purpura and organ involvement such as membranoproliferative glomerulonephritis, peripheral neuropathy, vasculitis and chronic liver diseases. Cryoglobulinemia is quite frequent in chronic HCV infection and especially when appropriate techniques of cryoglobulin detection are applied. Its frequency is usually higher in older male cirrhotic patients and who have a longer duration of HCV infection. The term essential mixed cryoglobulinemia [EMC] has been used to describe the syndrome with no evidence of underlying disease. Chronic HCV infection is the main cause [90%] of EMC type II and III with or without clinical or biochemical evidence of liver damage. In addition, HCV was described as a lymphotropic virus and may play a direct role in the development of low grade non-Hodgkin's lymphoma which is usually associated with EMC. Aiming to estimate cryoglobulins in patients with CHC viral infection to identify the possible correlation between cryoglobulinemia and CHC viral infection, we conducted this study on 40 patients with CHC viral infection. Another group of 10 normal persons was considered a control group. Among our patients, there were 32.5% positive patients for cryoglobulinemia, those patients had increased incidence of cirrhosis and low C4. We suggested that EMC associated with HCV infection should no longer be referred to as essential but rather as hepatitis C associated with MC. In addition, every patient with chronic HCV infection may have MC, so that serum cryoglobulins and complement components must be evaluated repeatedly during the course of chronic HCV infection for avoiding their complications

Myocardial performance in patients with chronic renal failure

The present work has been designated to re-assess the left ventricular morphofunctional changes by echocardiography in a group of non- dialyzed uremic as well as continuous ambulatory peritoneal dialysis [CAPD] and hemodialysis [HD] cases, together with clinical and laboratory assessment with a special attention to serum Ca, Mg, Zn, Cu, Fe, and Co. Myocardial suppression by uremic toxins was suggested but no such specific uremic toxins were isolated, yet trace metals were suggested to play an important role. The study involved 20 cases on conservative treatment, 20 cases on CAPD and 20 cases on HD, in addition to 20 control subjects. Patients with valvular heart disease, pericardial effusion, diabetes, manifested heart failure or any acute illness were excluded. The results of this work reflected the basal left ventricular function and represent a high prevalence of subclinical myocardial dysfunction, as well as significant morphological alterations. On the other hand, the studied biochemical parameters [serum creatinine, Ca, Mg, Zn, Cu and Fe] were not correlated to the studied left ventricular morphofunctional parameters