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

comparative profile of neurological soft signs [NSS] in first degree relatives of schizophrenia, and bipolar disorder

Evidence for the higher prevalence of NSS in schizophrenics and their 1[st] degree relatives is substantial whereas evidence for the specificity of the subtypes of the NSS is relatively sparse. This study was performed to find out if there is a subset of NSS discriminating 1[st] degree relatives of schizophrenic when compared with 1[st] degree relatives of bipolar disorder patients or control. The study included 52 healthy subjects having first degree relative with either schizophrenia or bipolar disorder and 20 healthy subjects with no first degree relative suffering from schizophrenia or bipolar disorder. These subjects were assessed psychiatrically to ensure that they don't suffer from any psychiatric disorder and to diagnose their related psychiatric patient. This assessment was done using Mini International Neuropsychiatric Interview and the diagnosis was done according to DSM IV TR. Then the subjects were assessed neurologically to ensure that they have no neurological disorders and to detect the presence of NSS using Cambridge Neurological Inventory [part 2]. The results showed that the first degree relatives of schizophrenics have significant higher scores on a subset of tests for integration of sensory information [namely graphesthesia and rhythm tapping]. This study encourage studying the first degree relatives of the patients to identify endophenotypes of psychiatric disorders, and also further research on the underlying neuroanatomy of the different subsets of NSS

Homocysteine in Parkinsonian patients

The work is designed to estimate in Parkinson 's disease [PD] patients the effect of levodopa treatment on plasma total homocysteine [HCY] level which is an important risk factor for atherosclerosis and also, cause neuronal death by activating apoptosis. This study included 57 PD patients in addition to 10 age and sex matched healthy participants, as control group. The patients were divided into two groups; group I [n = 43] which included those who received levodopa and group II [n = 14] which included those who didn 't receive levodopa. In this study we found elevated plasma level of total homocysteine in levodopa treated Parkinson's disease patients compared to non treated patients and control, and it was significantly positively correlated with the duration of treatment irrespective of the dose of levodopa. From this study we concluded that levodopa therapy for PD is associated with increased HCY level. This increase in HCY level accelerates the death of dopamine producing cells and impairs the function of energy producing mitochondria and increases oxidative stress. So, we recommend the prescription of folic acid which is an inexpensive and well tolerated HCY lowering therapy together with levodopa, together with catechol-O-methyl transferase inhibitor to decrease the formation of HCY from levodopa via the O-metabolization pathway

Correlation of signal intensity of idiopathic parkinson's disease with clinical findings and response to therapy

To correlate the signal intensity [SI] of the substania nigra [SN] on T2 weighted MR image with clinical findings and response to Levo-dopa in patients with idiopathic Parkinson's disease [IPD]. Prospective study was conducted upon 100 elderly patients with IPD [52 men, 48 women aged from 45 to 79 with mean age [58.8 +/- 8.82] and 25 age and sex matched volunteers. Thirty-seven of the patients were without treatment and 63 were under levo-dopa therapy. The patients were assessed according to Hoehn and Yahr rating scale. Routine T1 and T2 weighted MR imaging of the brain was done on 1.5 tesla unit [Symphony, Siemens]. The parameters used were TR/TE: 10000/38 msec. The SI of the SN on T2 weighted image was calculated. There was statistically significant difference in SI on T2 weighted image between patients with IPD and volunteers [P<0.001]. The SI correlated with disease onset [P = 0.252] and duration [P<0.001]. Also, there was correlation between SI of SN and disease severity [P < 0.001]. There was significant difference in the SI of SN between patients without treatment and patients with under levo-dopa therapy [T- 8.04, P<0.001]. We concluded that signal intensity on T2 weighted images is correlated with clinical score as well as with response for levo-dopa therapy