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

Role of leptin in patients with chronic idiopathic thrombocytopenic purpura [ITP]

Leptin hormone, synthesized by the adipose tissue, binds with a receptor member of the class I cytokine receptor family. It plays a role in the pathogenesis of several autoimmune diseases. Idiopathic thrombocytopenic purpura [ITP] constitutes the prototype of autoimmune diseases characterized by the production of the autoantibodies against platelet antigens, resulting in enhanced destruction of the platelets by macrophages. Recently, more evidences have been found related to the effects of hormones on the immune system, including their effect on autoimmunity. The aim of this study was to evaluate serum leptin level in patients with chronic ITP in order to determine the role of leptin in the pathogenesis of ITP. This study comprised 40 patients with chronic ITP and 20 healthy controls of similar age, sex and body mass index [BMI]. Serum leptin level was measured by enzyme amplified sensitivity immunoassay [EASIA]. It was found that, the mean serum leptin level in patients with ITP was significantly higher [P<0.001] than in healthy controls. Furthermore, the positivity of platelet-associated antibodies [PAIgG] and platelet count was significantly different between leptin-positive [level greater than mean of control value + 2SD] and leptin-negative patients. From the present study we can conclude that leptin might play an important role in the pathogenesis of ITP

Extracellular accumulation of bioactive substances; interleukin -1beta [IL-1beta] and plasminogen activator inhibitor-1 [PAI-1] in stored blood units, relation to bacterial contamination

Bacterial contamination of blood and its cellular components remains an unresolved problem in transfusion medicine. Its relation to release of some bioactive substance from cellular blood components is not determined. The present work was designed to explore the levels of two bioactive compounds Interleukin-1 beta and Plasminogen activator inhibitor-1 in stored blood and their relation to bacterial contamination of these units. This study was conducted on 112 blood units obtained from blood bank of Mansoura University Children Hospital. Sequential blood samples were obtained both immediately after donation and 10 days after for measurement of interleukin-1 beta and Plasminogen activator inhibitor-1 and for bacterial culture by BACTEC 9050 system. There was statistically significant increase in both IL-1 beta and PAI-1 [p= 0.0001] after 10 days of blood units storage. Bacteriological culture revealed no growth in 68% and positive growth in 32% of blood units. The commonest isolated organism was Staph. aureus [15%] followed by Staph. epidermedis [13%] then Yersinia sp. and Enterobacter sp. [2%] for each.From the present study we could conclude that; stored blood units contain platelets and WBCs derived bio-active substances PAI-1 and IL-beta which increase with the duration of blood storage. Furthermore, the extended duration of storage carries the danger of blood contamination by bacteria. Automated blood culture system seems to be helpful in identification of bacterial contamination of blood units. We recommend fresh blood transfusion as early as possible and the practice of Leucofilteration to avoid blood transfusion complications