Serum level of tumor necrosis factor-alpha in patients with hepatic encephalopathy due to chronic liver diseases

Tumor necrosis factor-alpha [TNF-alpha] is involved in many acute and chronic liver disease [CLD]. This work was conducted on 69 patients with CLD [50 patients with overt hepatic encephalopathy [HE] and 19 patients with no evidence of HE] and 13 healthy subjects as a control group. The aim was to assess the serum level TNF-alpha in patients with HE due CLD and to correlate this level with the severity and precipitating factors of HE. All patients and control subjects were subjected to clinical, laboratory and abdominal ultrasonography in addition to measurement of serum level of TNF-alpha. HE was more common in male patients [P<0.002] but not related to the age [P = 0.826]. Serum TNF- alpha level was significantly elevated in patients with CLD in comparison with the control and patients with overt HE than those with no evidence of HE [16.88 pg/ml. 33.85 pg/ml and 78.48 pg/ml] respectively. TNF-alpha was positively correlated to the synthetic liver function but not related to the liver enzyme levels. TNF-alpha was positively related to the severity of liver disease represented by Child-Pugh score [P<0.001] being highest in Child C patients. The serum level of TNF-alpha was significantly correlated to the severity of HE reaching its highest levels in Grade IV. but not related to the precipitating factors of HE. serum level of TNF-alpha was higher in cirrhotic patients with HE and correlates with severity but not the precipitating factors of HE

Correlation between clinical presentation and genotypes of human giardiasis

The aim was to study the genotypes of human giardiasis and its relation to the symptoms of the clinical presentation. 105 patients. with giardiasis In the stool, 61 were symptomatizing and 44 were asymptomatic. and 20 subjects serving as a control group with negative stool examination for giradiasis. all were examined by PCR of stool to detect genotypes of G.L. PCR detected G.L. in 73.3% and failed to detect G.L in 26.7% of cases with G.L. in stool, and was negative in all control subjects. this mean. RCR specificity is 100% and sensitivity 73.3% for G.L. Three genotypes were detected, genotypes I in 36.19%. genotype II in 12.38% and genotype III in 9.52%, and mixed genotypes were detected in 15%, of cases with G.L In the symptomatic patients genotype I was 32.79%, genotype II was 16.39% and genotype III was 9.64%, mixed genotypes infection in 16.39% and undetermined genotypes was 24.59% while in the asymptomatic group. genotype I detected in 40.91% genotype II In 6.82%. genotype II in 9.59% mixed genotypes in 13.64% and undetermined in 29.55%. There was no statistically significant difference between symptomatic and asymptomatic group regarding G.L genotype distribution and the genotype of G.L was not related to symptoms of clinical presentation. the study revealed genetic diversity of G. Lamblia infection in the studied population and the genotypes of G. Lamblia were not related to the symptoms of clinical presentations

Neurophysiologic and psychometric changes in patients with liver cirrhosis

Because of its prognostic and socioeconomic relevance, interest has focused on SHE, which describes a poorly defined syndrome found in the grey zone between normality and manifest HE. the aim was to study the neurophysiologic and nero psychologic changes in chronic liver diseases to diagnoses subclinical heptic encephalopathy [SHE]. Sixty patients with chronic liver disease 30 had cirrhosis due to chronic HCV [group 1], and 30 patients had liver fibrosis due to Schistosomiasis [alone or with hepatitis] [group2]. and 20 healthy subjects as control [group 3], all were subjected to, clinical examination, assessment of liver function, routine tab., investigations, Abd, US. and EEG and psychometric assessment by [NCT] and symbol [SDT]. NCT abnormal score was found in 46.7% group2. ranging from 42.3% to 75% in Child-Pugh grade A, B respectively, however the control group had normal NCT score. Positive EEG changes were in [60%]and [50%] ranging from [47.05% to 76.92%] and from [46.15% to 75.0%], in group 1 and group 2 in Child-Pugh grade A and B, respectively, while in group 3 EEG was normal in [90%] and non specific changes found in[10%]. EEC changes and psychometric defects were detected in considerable percentage of cirrhotic patients and were related to the severity of liver cirrhosis, so psychometric tests and EEG may be suitable tools for diagnosis of SHE