Amplification of human telomerase reverse transcriptase gene as a diagnostic marker in lung cancer

Analysis of circulating DNA or RNA in plasma can provide a useful marker for earlier lung cancer detection. This study was designed to assess the sensitivity and specificity of a quantitative molecular assay of circulating RNA to identify patients with lung cancer with different grades. The amount of plasma RNA was determined through the use of real-time quantitative polymerase chain reaction [PCR] amplification of the human telomerase reverse transcriptase gene [hTERT] in 19 non-small-cell lung cancer patients and 10 age and sex matched controls. Performance of the assay was calculated through the receiver operating characteristic [ROC] curve. The hTERT mRNA ratio in cancer lung patients showed a mean of 196.34 +/- 307.23 which was higher compared to that of the controls 1.24 +/- 0.80; this difference was statistically highly significant where P<0.01. The median concentration of circulating plasma RNA in patients was higher than the value detected in controls [71.70 v 1.149 ratio]. Plasma RNA was a strong risk factor for lung cancer; concentrations in the patients were associated with a 62-fold higher risk than were those in the controls. The point of the best cut-off value was at 2.24 where sensitivity was 73.7% and specificity was 90%. The area under the ROC curve was 0.704. This study shows that higher levels of free circulating RNA can be detected in patients with lung cancer compared with disease-free heavy smokers by a PCR assay, and suggests a new, noninvasive approach for early detection of lung cancer. Levels of plasma RNA is recommended to be measured as it could also identify higher-risk individuals for lung cancer screening and chemoprevention trials

Biochemical markers of fibrogenesis in pediatric chronic liver diseases

Objectives: Non-invasive diagnosis of hepatic fibrosis has become the focus, especially in the surveillance of treatment and in screening hepatic fibrosis. To investigate the clinical usefulness of fibrogenesis markers in evaluating liver fibrosis, we determined serum levels of TGF-beta1, collagen IV, and laminin., and their relationships with frequently used liver function tests, and findings of liver ultrasonography and liver biopsy were investigated

Methods: 50 patients with chronic liver diseases were enrolled from the National Liver Institute, Menoufiya University. Serum markers of fibrosis, liver function indices [for the patients and 30 controls], and ultrasonography for all patients were performed and compared with histologic fibrotic changes

Results: Serum levels of TGF-beta1, collagen IV. and laminin were significantly higher in patients than those in control [P<0.000]. The levels of serum fibrosis markers were not correlated with fibrotic scores [P>0.05], but laminin was positively correlated to histologic activity index. There were no significant changes in the level of serum fibrosis markers related to ultrasonographic findings. Their levels were also not correlated to ALT or AST. The cut-off values, specificity and sensitivity were determined for all markers, among which collagen IV was the marker with the highest sensitivity and specificity

Conclusion: Serum level of TGF-beta1, collagen IV, and laminin can be used as indices for the diagnosis of hepatic fibrosis. Among them, collagen IV is more sensitive. Biochemical markers of fibrogenesis might be useful in regular monitoring of disease development and treatment effectiveness and should be inseparable part of progression assessment in all chronic hepatopathies

Plasma endothesin-1 and renin as predictor factors in schistosomal liver disease of children

Endotheh-1 [ET-1] is a mitogenic and a potent vasoconstrictor peptide. It affects the hemodynamics of the liver and plays a role in fibro genesis through activation of stellate cells. Also renin-angiotensin system, which is activated in liver cirrhosis, may play a role in the pathogenesis of portal hypertension associated with schistosomal liver disease. The role of plasma ET-1 and renin in schistosomal liver disease and their clinical significance remain largely under investigated particularly in children. This study included 20 patients attending Pediatric Department of National Liver Institute, Menoufyia University, or Pediatric Department of Tanta University Hospital. Their mean age was 10.2 +/- 2.1 years. A control group of 20 healthy children of matched age and sex was included in the study. For all study children, history, physical examination, urine and stool analysis, CBC, kidney function tests and liver function tests were undertaken. Rectal snip biopsy, abdominal ultrasound examination and liver biopsy were utilized to diagnose our patients. Plasma ET-4 and renin were measured by radioimmunoassay. The mean level of ET-1 in the control group was 0.83 +/- 0.20 pg/ml with a range of 0.49 to 0.99 pg/ml, In contrast, the mean ET-1 level in the patients group was 1,37 +/- 0.6 pg/ml with a range of 0.49 to 2.24 pg/ml. The difference was statistically significant [p=0.001]. ET-1 was found to be elevated [2 SD above the mean control value] in 9 of 20 patients [45 %] with mean of 7.8 +/- 0.37 pg/ml and a range of 1.49 to 2.24 pg/ml. ET-1 was elevated in 2/11 [19%] of patients with hepatomegaly, in 2/3 [67%] of patients with hepatosplenomegaly, in the only case with shrunken liver 1/1 [100%] and in 4/5[80%] of patients with ascites. The relation of ET-1 elevation to the stage of disease was statistically significant [p=0.026]. Elevated ET-1 was found in 6/1 [86%] of patients with elevated ALT, compared with 3/13 [23%] of patients with normal ALT. This relation was statistically significant [p=0.017]. Plasma ET-1 levels appeared to correlate with duration and severity of the disease. Unlike in cirrhotic patients previously reported, renin was normal in all studied cases with no significant difference between patients of all disease stages versus controls. in the control group the mean plasma renin level was 2.52 +/- 1.23 ng/L and ranged from 1.23 to 3.81 ng/L while in the patients group it was 2.09 +/- 1.06 ng/L and ranged from 0.72 to 3.45 ng/L. This might be attributed to the stable hemodynamics and normal renal function of our study cases

Conclusions: the present study suggests that ET-7 level might be elevated in cases of schistosomal liver disease of Egyptian children particularly advanced cases. Elevated ET-1 might be involved in the aggravation of the disease or development of complications like portal hypertension 3rd ascites. So, monitoring ET-1 level along the course of the disease may be useful as a predictor for the development of these complications and may be helpful in the prevention planning. Plasma renin measurement probably has no important role in following up schistosomal liver disease during childhood

Mesenteric vein thrombosis: a diagnostic and therapeutic challenge

Mesenteric vein thrombosis [MVT] is a rare but a potentially lethal form of mesenteric ischemia. Thirteen patients having MVT [7 males and 6 females] were included in this study. Their ages ranged from 30 to 50 years with a mean +/- standard deviation [SD] of [46.15 +/- 5.52]. Nine of these patients [9/13; 69%] had associated hepatopancreatic diseases: 4 with hepatocellular carcinoma [HCC] on top of cirrhosis, 3 with cirrhosis and previous splenectomy, one with cirrhosis, and one with pancreatitis. The remaining four patients [4/13; 31%] had associated nonhepatopancreatic disease: 2 with deep venous thrombosis [DVT], and 2 with history of contraceptive pill intake. Severe subcontinuous abdominal pain out of proportion to the physical findings [11/13; 84%] and abdominal distention [9/13; 69%] were the major symptoms. Color duplex ultrasound [US] was performed in all patients and was diagnostic for MVT in only 10 patients [10/13; 77%]. In the remaining 3 patients, diagnosis of MVT was established by computed tomography [CT] in 2, and mesenteric angiography in one. Once the diagnosis of acute MVT was confirmed, all patients were anticoagulated with heparin.Signs of peritonitis were the main indication for immediate exploratory laparotomy in the studied cases [8/13; 61.5%]. Minimal small bowel resection with primary anastomosis was performed in 5 patients, minimal small bowel resection with diverting ileostomy in one, extended small bowel resection with primary anastomosis in one, and laparotomy without resection in one. The determination of viability in the marginally perfused bowel was done with clinical assessment. For further evaluation of bowel viability in borderline cases, Doppler US was performed in 4 patients. The 30-day operative mortality was reported in three patients [3/8; 37.5%]. All of them were having liver cirrhosis that was associated with malignancy in one and splenectomy in another. The 30-day mortality in the five non-surgically treated patients was 60% [3/5] that was mostly due to advanced liver malignancy. In conclusion; a high index of suspicion and recognition of high risk factors coupled with a history of non-specific abdominal symptoms should alert clinicians to the possibility of MVT. Early diagnosis using color duplex US or CT and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel. Although a primary anastomosis can be accomplished in most situations, a diverting ileostomy may often be the prudent approach in cases with poor liver function and bad general conditions. During operation, all nonviable bowels should be resected with intent for a second-look laparotomy after 24 hours if there is any question of ongoing ischemia. We recommend using intraoperative Doppler US for detection of the arterial signals in evaluation of the marginally viable bowel

Mother-to-infant transmission of hepatitis C virus [HCV]

Hepatitis C Virus [HCV] infection is a major endemic health problem in Egypt. The risk of vertical transmission of HCV is reported to be highly variable. In Egypt, there is little information about the course of HCV during pregnancy and its vertical transmission. To estimate the seroprevalance rate of HCV infection during pregnancy and to evaluate the clinical aspects of HCV liver disease in mothers with HCV antibodies [HCV Ab's] positive, both during pregnancy and six months after delivery, and to assess the outcome of pregnancy. Prospective clinical study. Departments of Obstetrics and Tropical Medicine, Faculty of Medicine, El Menoufia University. Twenty hundred consecutive pregnant women were studied during a 2-year period, Serologic screening for HCV Ab's was done using ELISA 3. Women found to be positive were tested further using PCR for HCV-RNA. Clinico-biochemical assessment, follow up and recording of the fetal outcome were done. At birth, and at six months age, offspring were tested for HCV Ab's and HCV- RNA. HCV Ab's were positive in 18% [360/2000] of pregnant women and of these HCV-RNA was positive in 7.8% [28/360], Liver function tests [included transaminases] were within normal range in all mothers during pregnancy and six months after delivery. In all women the outcome of pregnancy was favorable. All the neonates born to HCV Ab's positive mothers were positive for HCV antibodies at birth and only one [0.3%] was positive at 6 months. All babies were negative for HCV-RNA. Although there is no evidence of vertical transmission of HCV, further studies together with long term follow up of seropositive mothers and their infants are recommended. HCV infection is only surely diagnosed by PCR for HCV-RNA. Pregnancy does not induce deterioration of liver disease and vice versa, HCV infection does not increase the risk of obstetric complications. National health awareness, guidelines, control methods are the main items for prophylactic programs against HCV. Cost benefit analysis of national screening program, for HCV infection must be considered and routine screening for HCV Ab's during ANC is recommend

Study of degenerative changes of conjunctiva associated with cement industry

This work was conducted to study the effect of exposure to cement on development of degenerative changes on conjunctiva whether directly in industry or indirectly through air pollution. A total sample [3625] were submitted to conjunctival examination; 2051 exposed of 26 non exposed workers, 970 exposed and 340 non exposed inhabitants. The degenerative changes were detected among 87.5% of exposed versus 12.2% of non exposed workers and among 45.6% of exposed versus 11.5% of non exposed inhabitants. The significance of occupational exposure to cement dust on development of degenerative changes of conjunctiva of exposed workers and inhabitants was stressed through comparison between the different studied groups