Evaluation of serum levels and significance of soluble CD40 ligand in screening patients with hepatitis C virus-related hepatocellular carcinoma

The study's objective was to evaluate the clinical significance of sCD40L in HCV- associated hepatocellular carcinoma [HCV-HCC] patients. Sera concentration of circulating sCD40L and IL-10 were assayed using ELISA in 30 HCV positive patients with HCC, 30 HCV-positive patients with liver cirrhosis and 30 age-matched healthy volunteers with negative anti-HCV-Ab as a control group. Serum sCD40Lshowed statistically-significant high levels in HCV-HCC patients compared to HCV-cirrhotic patients and normal controls [P < 0.001]. Serum sCD40L had higher diagnostic value in HCC patients compared with serum AFP. High sensitivity and specificity of sCD40L was observed compared to AFP [90%, 86.7% and 83% and 80% respectively]. Significant positive correlation was detected between serum sCD40L and IL-10[r = 0.85 P < 0.001], AFP [r = 0.62 P < 0.05] and tumour staging [r = 0.5 P < 0.05]. The study concluded that sCD40L is a valuable diagnostic tool in early diagnosis and screening for HCV and HCC as well as routine follow up of HCV cirrhosis patients. Assessment of serum IL-10 levels in HCV patients may provide a possible predictive marker for disease progression

Correlating brain stem auditory evoked potentials measurement to clinical and neurophysiological findings in patients with diabetes mellitus

Diabetes mellitus is a multisystem metabolic disorder. One of its rarely probed complications is brainstem dysfunction. We investigated brainstem auditory evoked potential studies [BAEPs] in diabetic patients, as well as its to microangiopathy. The study was conducted on 40 [type 1 and type 2] diabetic patients, calssified into: group [< 5 years duration of illness] and group 11 [> 5 years duration of illness]. The patients were examined clinically and neurologically. Neurophysiological tests in the form of: BAEPs, nerve conduction studies and flash electroretinography were performed to all patients. Urine analysis, instantaneous random blood sugar and funduscopy were also performed for patients. The BAEPs patients' results were compared to those of 30 normal subjects. Wave V absolute latency, III-V IPL and I-V IPL were positively correlated with the patients' age. Latency of wave III and V/I amplitude ratio were significantly higher in male patients. Tinnitus was associated with statistically significant increase in wave V latency, III-V IPL and I-V IPL. The same finding was reported in the 21 patients who showed evidence of nerve conduction abnormalities during nerve conduction studies. Retinal changes detected by fundus examination and abnormal F-ERG was associated with statistically significant increase in wave III latency. Brainstem dysfunction occurs early in the course of diabetes [type I and III similarly] and it is further affected by its duration. BAEP studies will be of help in detecting early subclinical central nervous system involvement in diabetic patients

Markers of type II collagen synthesis and degradation as a predictor of radiographic progression in knee osteoarthritis

The aim of this study was to evaluate serum PIIANP and urinary CTXII as a parameters of type II collagen synthesis and degradation, respectively, in patients with OA knees and to investigate whether the use of these two molecular markers could predict the progression of joint damage evaluated by radiography during a period of 3 years. Sixty patients had symptomatic primary knee OA of Kellgren-Lawrence [K-L] grade I-III and met ACR criteria. These patients were evaluated prospectively for 3 years. Serum PIIANP and urinary CTX-II levels were measured by ELISA at baseline and at study end and their levels compared according to the changes in joint space width [JSW], K-L grade and WOMAC index, over 3 years. Also, we assessed the diagnostic value of those molecular markers and their performance for prediction of radiological progression. Serum and urinary levels also compared with 40 matched healthy subjects as a control group. There were significant decrease in the baseline serum PIIANP [P<0.001] and increase in the baseline urinary excretion of CTX-II [P<0.001] in knee OA patients in comparison with the control, in bilateral than unilateral cases [P<0.05], [P<0.05] and also with increasing the K-L radiological severity of the disease [P<0.05], [P<0.001], respectively. There were significant decrease in the mean baseline serum PIIANP and highly significant increase in the mean baseline urinary excretion of CTXII in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of the signal or both knees [P<0.05], [P<0.001], respectively. There were significant decrease in the mean study end serum PIIANP and highly significant increase in the mean study end urinary excretion of CTX-II in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of signal or both knees [P<0.05], [P<0.001], respectively. There were insignificant correlation between serum PIIANP and urinary CTX-II either at the baseline or study end and also insignificant correlation between those molecular markers with disease duration, BMI and WOMAC index [P>0.05]. Urinary CTX-II showed a higher diagnostic sensitivity and specificity [75% - 92%] than serum PIIANP [60% - 90%], respectively. The diagnostic specificity was greatest when both tests were found in combination [96%]. Also, combination of tests showed higher diagnostic sensitivity [92.3%] and specificity [55.3%] for predicting the radiological progression over 3 years than either one alone. In conclusion: using specific molecular markers serum PIIANP and urinary CTX-II, we found that patients with knee OA are characterized by depressed type II collagen synthesis and increased type II collagen degradation. Combining these two molecular markers allows the identification of patients with a high risk of subsequent progression of joint damage

Management of postoperative emesis after gynecological diagnostic laparoscopy: comparison between metoclopramide and droperidol

54 female patients undergoing diagnostic gynecological laparoscopy were divided into three equal groups in order to evaluate the incidence of postoperative nausea and vomiting which commonly accompany this procedure and the efficacy of metoclopramide and droperidol in lowering this incidence. Group 1 did not receive any antiemetic drug postoperatively, group 2 received 10 mg of metoclopramide 10 min. before the end of the procedure, while group 3 received 15-20 ug/kg droperidol at the same timing, additional doses of the same particular antiemetic drug were given when needed. Patients were observed at thirteen observation periods regarding postoperative nausea and vomiting along seven postoperative hours. Results were tabulated and statistically analyzed. Patients in control group showed significant higher incidence of postoperative nausea and vomiting, patients in the group who received metoclopramide responded better than those who received droperidol. Metoclopramide had a faster onset of action than droperidol which lasted for longer duration but patients whom received it were more sleepy postoperatively. It was concluded that metoclopramide is superior to droperidol in the prophylaxis and treatment of postoperative nausea and vomiting which usually occur after gynecological laparoscopy