The role of serum visfatin and vaspin in hepatocellular carcinoma in hepatitis C-related liver cirrhosis.

Aim of the study: To investigate the role of the novel adipokines visfatin and vaspin in hepatitis C virus (HCV)-cirrhotic patients with and without hepatocellular carcinoma (HCC) and their association with tumour characteristics and liver dysfunction. Material and methods: This case-control study was carried out between March 2021 and September 2021. Serum visfatin and vaspin were measured in 67 HCV-cirrhotic patients (37 had HCC, and 30 did not) and 20 healthy individuals using enzyme-linked immunosorbent assay (ELISA). Results: Serum visfatin and vaspin were substantially elevated in HCC patients compared to those without HCC and healthy controls (p = 0.001, < 0.0001, respectively) and significantly associated with hepatic dysfunction. At a cut-off value of 12.1 ng/ml, the sensitivity and specificity of the serum visfatin in detecting HCC were 67.6% and 83.3%, respectively. Serum vaspin at a cut-off value of 321 ng/dl had a sensitivity of 94.6% and specificity of 66.7%. In multivariate regression analysis, serum vaspin and albumin were independent risk factors for HCC development. Patients with Barcelona Clinic Liver Cancer (BCLC) stage D had significantly the highest serum levels of visfatin and vaspin (p = 0.03, 0.008, respectively). Conclusions: Serum visfatin and vaspin were substantially higher in HCC patients, associated with tumour stage, and might be considered as potential biomarkers of HCC, but this should be confirmed in larger independent cohorts of patients with liver cirrhosis. Serum vaspin and albumin were independent risk factors for HCC development. There was a substantial association between visfatin, vaspin, and the severity of the underlying liver dysfunction.

Negative ANA-IIF in SLE patients: what is beyond?

The antinuclear antibody (ANA) test has high sensitivity in diagnosing and classifying systemic lupus erythematosus (SLE). OBJECTIVES: To describe the immunological pattern of SLE patients through investigating specific antinuclear autoantibodies by enzyme dot immunoassay and studying their frequency in both positive and negative ANA indirect immunofluorescence assay (IIF) cases. METHODS: In a cross-sectional study, blood samples from 393 newly diagnosed SLE patients were analyzed using (IIF) on HEp-2 cells and ANA dot immunoassay by automated enzyme immunoassay (EIA) to detect 19 antibodies. RESULTS: Ninety-one percent of the patients are females; their mean age was 37 ± 12.28. Antinuclear antibody (ANA) was detected by IIF in 82.4% of cases, with 181 (46.1%) speckled and 167 (42.4%) homogeneous ANA patterns. The majority of patients (96%) demonstrated autoantibodies via EIA. Among the ANA-IIF-negative patients, 97.2% demonstrated autoantibodies. There was a significant difference in the frequency of certain autoantibodies between SLE patients with negative and positive ANA-IIF (1.44 0.73, 3.12 2.09, p = 0.00) respectively. CONCLUSION: The results of analyzing 19 autoantibodies with the ANA staining pattern increased the significance of analyzing the immune profile even if IIF is negative when clinical symptoms strongly suggest SLE diagnosis. Certain autoantibodies may evade staining by the IFA approach while they are present in the patient's serum, and they may not be detected by the ANA EIA profile if it does not contain that antigenic substrate. Key Points • Indirect immunofluorescence on Hep-2 is the conventional method for ANA detection and is regarded as the "gold standard" for testing in clinical practice for SLE. • In our study, ANA profile dot enzyme immunoassay (EIA)-based test was performed to evaluate 19 autoantibodies in SLE patients either positive or negative for ANA-IIF. • The presence of anti-dsDNA with ANA-IIF-negative serum in 32.4% of SLE patients provides evidence that not all anti-dsDNA antibodies are identified on standard HEp-2 substrates. • certain autoantibodies can evade staining by the ANA-IIF method despite being present in the SLE patient's blood; this supports the ANA profile enzyme dot immunoassay as a more sensitive test.

Immunoglobulin G antibody immune response profile following infection with SARS-CoV-2 in COVID-19 Egyptian patients.

This study aimed to report the dynamic profile of IgG-specific antibodies to SARS-CoV-2 infection for 6 months after infection. We conducted a prospective study, recruited 33 recently confirmed covid -19 patients and collected 6 samples from each patient. The first samples were collected one month from the start of symptoms and subsequent samples collected at 30 days interval. We measured the IgG by chemiluminescent immunoassay (CLIA). According to the disease severity, patients were categorized as asymptomatic 4 (12.1%), mild 14 (42,4%), moderate 9 (27.3%), and severe 6 (18.2%). Patients were 12 (35.3%) females and 21 (64.7%) males. The mean IgG levels maintained a high level till the second month (92.81 ± 110.15 AU/ml) from the onset of symptoms followed by a gradual decrease till the sixth month after infection (17.42 ± 22.61 AU/ml). The patients with severe symptoms significantly exhibited the highest IgG levels, reached the highest level (mean=237.44 ± 164.13 AU/ml) at the second month. While the lowest levels were detected among the asymptomatic patients (mean= 3.04 ± 2.94 AU/ml) at the second month. Older age correlated with higher IgG antibody level (r= 0.350 p=0.046); however, sex was not related to IgG level. In conclusion, Symptomatic COVID-19 disease is followed by protective immunity for more than 6 months. Immunity in asymptomatic patients is low and fades rapidly than symptomatic cases. Patients with severe disease had significantly higher IgG levels compared to mild, moderate, or asymptomatic patients.

Association of anti-neutrophil cytoplasmic antibody in ischemic stroke Egyptian patients with hepatitis C virus.

Some studies reported a high prevalence of ischemic stroke in hepatitis C virus patients, other several studies have suggested that hepatitis C virus (HCV) may act as a trigger for autoimmune diseases and autoantibodies including Anti-Neutrophil Cytoplasmic Antibody (ANCA) which predispose to vasculitis. Because vasculitis is a risk factor for ischemic stroke, we investigated the association of the hepatitis C virus with ANCA in first-ever ischemic stroke patients. This study included 67 Egyptian patients with first-ever ischemic stroke. These patients were clinically examined and investigated for HCV infection by chemiluminescence & Real Time-PCR, and ANCA antibodies by ELISA. Forty-two patients (62.7%) had HCV infection. Twenty-nine (43.2%) of them were cytoplasmic- Antineutrophil Cytoplasmic Antibodies (c-ANCA) positive, while none was perinuclear- Antineutrophil Cytoplasmic Antibodies (p-ANCA) positive. Comparison between c-ANCA positive and ANCA negative patients showed that 82.8% and 47.4% had anti-HCV antibody, respectively, with P-value 0.003. The c-ANCA level correlated significantly with age, and HCV antibody level. No statistically significant difference was found in both the consciousness and stroke severity between the negative and positive c- ANCA patients. However, patients with positive c-ANCA had smaller and multiple cerebral infarctions with P-value 0.002 and 0.01 respectively. Multiple regression analysis showed that the number and size of cerebral infarctions were independent predictors of c-ANCA positivity with P value 0.02, and 0.03 respectively. In conclusion, c-ANCA level correlates with HCV antibody and may predispose to ischemic stroke by a possible ANCA associated vasculitis.

Assessment of Coronavirus in the Conjunctival Tears and Secretions in Patients with SARS-CoV-2 Infection in Sohag Province, Egypt.

PURPOSE: To assess SARS-CoV-2 virus in conjunctival tears and secretions of positive confirmed COVID-19 patients. METHODS: A case series study that included 28 positive COVID-19 patients confirmed with nasopharyngeal swab in the period 18-28 May 2020 at Sohag Tropical Medicine Hospital. Tears and conjunctival secretions of these confirmed positive cases were collected with disposable sampling swabs at interval of 3 days after admission due to respiratory symptoms. They were examined for the presence of SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) assay. RESULTS: Thirteen (46.43%) patients were stable, 4 (14.28%) patients suffered from dyspnea, 3 (10.72%) patients suffered from high fever, 5 (17.85%) patients suffered from cough, and 3 (10.72%) patients were on mechanical ventilation. Ten (35.71%) patients suffered from conjunctivitis. Tear and conjunctival swabs were positive in 8 (28.57%) patients, while other patients' swabs were negative (71.43%). Out of 10 patients with conjunctival manifestations, 3 patients had SARS-CoV-2 in their conjunctiva using (RT-PCR) test. Out of the 18 patients with no conjunctival manifestations, 5 patients had positive SARS-CoV-2 in their conjunctiva using (RT-PCR) test. CONCLUSION: The SARS-CoV-2 virus could be found in tears and conjunctival secretions in SARS-CoV-2 patients with or without conjunctivitis.

Serum Mannose - Binding Lectin in Egyptian Patients with Chronic Hepatitis C.

Approximately 60 - 85% of HCV infections cannot eradicate the virus and progress to chronic hepatitis, this may be explained by failure in host immune responses or by the ability of HCV to defeat host defense mechanisms. Mannose-binding lectin (MBL) may play an immunomodulatory role. This work intended to evaluate the relationship of MBL concentration to chronic HCV infection. Two groups, a patient group (n=50) with chronic hepatitis C, and a control group, (n=35) apparently healthy non-infected subjects were studied. MBL was measured by ELISA in both patients and controls. MBL was higher in chronic HCV patients (1159.86 ± 710.29) than in controls (329.7 ± 68.0) (p < 0.001). There was a negative correlation with the level of vireamia, and a positive correlation with the alpha-fetoprotein level. We conclude that MBL may play a role in modulating host immunity, persistence of HCV infection and the disease progression.

GENETIC POLYMORPHISM OF TOXOPLASMA GONDII FROM RECENTLY INFECTED ABORTED EGYPTIAN WOMEN.

Toxoplasmosis caused by Toxoplasma gondii is one of the most prevalent parasitic diseases in human beings. Human toxoplasmosis can be associated with serious clinical manifestations, particularly in developing fetus. The aim of the current study was to identify the possible lineage type of Toxoplasma gondii, molecularly detected in placental samples of women whose pregnancies were spontaneously terminated in the first trimester. Preliminary detection of Toxoplasma genomic materials was done by a SYBR green qPCR technology. Subsequent identification of Toxoplasma strain was done for the positive samples using PCR-restriction fragment length polymorphism (RFLP) at the SAG2 loci of T. gondii using restriction enzymes HhaI and Sau3AI. Out of 72 tested samples, Toxoplasma B1 gene was detected in 9 cases. Toxoplasma genotypes I and II in addition to unknown type were identified in 4, 3 and 2 cases respectively, while type III was not detected in our samples, hence excluded as a leading cause of abortion in humans in our preliminary study. Nevertheless, it remains uncertain to what extent the genotype of the parasite directly contributes to the clinical severity of human toxoplasmosis. Certainly, advanced molecular techniques targeting different Toxoplasma strains are crucial for better understanding of human toxoplasmosis. For more elucidation, additional studies are recommended intended for genetic characterization of such serious parasitic infection using larger number of samples.