Complete Blood Picture Research Articles

Impact of Immediate Nursing Care for Hepatic Encephalopathy Patients to Reduce Gastrointestinal Complication on Patient's Outcome in Intensive Care Unit at Main Assiut University Hospital

Immediate care is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely .Oxygen is administered if oxygen de-saturation occurs. The nurse monitors for fever or abdominal pain. This may be a signal the onset of bacterial peritonitis or other infection. Aim of the study was to investigate the immediate nursing care for hepatic encephalopathy patients' to reduce gastrointestinal complication on patient's outcome. Subject and methods descriptive research design was used to conduct this research. The sample of this study was consisted of 60 patients. Tools used in this study comprised three main tools. Tool 1:- patients assessment sheet. Tool 11:-fluid intake and| output and nutrition assessment. Tool 111:- Evaluation sheet. The main result:- Regarding West- haven criteria there was a significant decrease for the studied group from 1st day and 2nd day. There were statistical significance differences between the two days. Regarding complete blood picture; WBC in the studied group showed that significant decrease on 2nd day. Fluid intake & output in the studied group showed that significant increase on 2nd day. Conclusion:- Applied immediate nursing care significant to reduce gastrointestinal complication in hepatic encephalopathy patients and improve the patient's outcome. Therefore, it is recommended to providing nutritional counseling for all patients with hepatic encephalopathy, continuing Educational Nursing Programmes to access the high quality of care.

P selectin and T cell profiles provide verification to understand the pathogenesis of liver cirrhosis in HCV and Schistosoma mansoni infections

Hepatitis C virus (HCV) and Schistosoma mansoni are two major causes of chronic liver disease (CLD). Both immune alteration and thrombocytopenia are common complications in the majority of cirrhotic patients. The current study aimed to monitor the effect of T cell profile and platelets activation on the pathogenesis of liver cirrhosis in patients suffered from single or concomitant schistosomiasis and HCV infections. The subjects were divided into 4 groups: Group I, patients infected with schistosomiasis; Group II, patients infected with HCV; Group III, patients with combined liver diseases and Group IV: healthy individuals. All groups were subjected to full clinical evaluation as well as laboratory examination including ELISA anti-HCV antibodies screening, parasitological examination, and complete blood picture as well as flow cytometry for CD41, CD42, CD62P (P selectin), CD63, CD4 and CD8. The platelets count was significantly decreased in HCV and/or schistosoma infected patients compared to controls. The percentage of the total T-lymphocytes and T-helper was significantly reduced in all infected groups, while the percentage of T-cytotoxic was increased. The patients possessed a significantly higher percentage of the platelets activation markers than control group. There were considerable correlations between the platelets counts and P selectin and MFI. Thrombocytopenia was a common finding in patients with CLD. Patients with CLD showed increased platelets activation which may contribute to the occurrence of thrombocytopenia and play a role in the pathogenesis of CLD. Infected patient showed reduction in the cell-mediated-immunity as evidenced by low T –helper cells.

A Pilot Study for the Detection of FLT3-ITD Mutation Frequency in 25 Iraqi Patients With Acute Lymphoid Leukemia in 2 Iraqi Hospitals

This study was conducted to evaluate the frequency of FLT3-ITD mutation in acute lymphoid leukemia (ALL) patients using conventional polymerase chain reaction (PCR) in Iraq, and to correlate this mutation with prognostic parameters of patients. A total of 25 individuals were enrolled (16 children with ALL and 9 adult with ALL), attending 2 teaching hospitals in Baghdad. Hematological investigations including complete blood picture, and bone marrow aspiration were performed. FLT3-ITD mutation was detected utilizing conventional PCR technology using specific primers. Two of 25 ALL patients (8%) showed a mutated band of FLT3-ITD mutation representing 12.5% of pediatric patients, and all the other ALL cases showed the absence of this mutation. These cases were an 8-year-old girl and a 7-year-old boy, L2 subtype, who had achieved complete hematological remission throughout the study. In conclusion, FLT3-ITD mutation was found in 2 morphologically appearing pediatric ALL patients that was higher than previously reported worldwide. Bilineage cases could not be excluded owing to absence of flow cytometer analysis. A larger number of Iraqi ALL patients confirmed by flow cytometer is necessary to evaluate the prognostic effect of this mutation in pediatric age group, especially FLT3 tyrosine kinase inhibitors might represent a promising target in ALL patients and can be used as minimal residual disease marker.

English

Background and objective: Anaemia is often an unrecognized complication of diabetes mellitus that has adverse effect on the progression of diabetes related complications. Contributors to its development include erythropoietin insufficiency and iron deficiency. The aim of this study was to assess the prevalence of iron deficiency anaemia and anaemia of chronic disease among diabetic patients. Methods: Over a period of six month from November 2010 to May 2011, 250 diabetic patients, attending Layla Qasim diabetic center were studied, their age ranged between 18-73 years. Venous blood samples were collected from each of them. A complete blood picture, iron study, HbA1c% and fasting blood glucose were performed. According to the duration of diabetes, patients were divided into three groups: group I patients (duration of diabetes < 5 years), group II (duration of diabetes between 5-9 years) and group III (duration of diabetes ≥10 years). Results: One hundred ten patients (44%) were found to have anaemia. The frequency of anaemia was more among group III (46.6%). Higher prevalence of anaemia was found among female patients (53.9%) than male patient (24.1%). Among anemic patients, 72 patients (65%) considered as having anaemia of chronic disease (ACD), 26 patients (24%) were iron deficiency anemia (IDA), 11 patients (10%) were thalassemia trait and one patient (1%) had autoimmune hemolytic anaemia. ACD was more frequent among group II (80%) and group III (70.4%), while IDA was more frequent among group I (12.6%). both ACD and IDA were more frequent among female patient than male patients (34.7% and 13.8% respectively). There was no significant correlation between HbA1c and Hb, serum iron parameters and S.ferritin. Conclusion: It was concluded that anaemia is common among diabetics and remains unrecognized by both physicians and patients; it is more common among female diabetics. The commonest type of anaemia among diabetic patients is ACD followed by IDA.

Frequency of Cholestatic Liver Diseases in Zagazig University Hospitals, with Special Emphasize on Extrahepatic Causes

Background and study aim : Extrahepatic cholestasis results from the mechanical obstruction of large bile ducts outside the liver or within the porta hepatis. The common etiologies of cholestasis have been reported to vary from one center to another. Our aim was to assess the frequency of cholestatic disorders in patients admitted to our department and try to identify the underlying extrahepatic causes aiming at improving the quality of management offered to this patients group. Patients and methods: In the present study, 506 cases admitted to our department were included. Sixty one of them met our inclusion criteria, of high serum alkaline phosphatase (ALP≥1.5 times the upper limit of normal), high gamma glutamyl transferase (GGT≥3 times the upper limit of normal) and ultrasonogrpahic (US) features of extrahepatic cholestasis (dilated intra and/or extra-hepatic ducts) of whatever etiology. The selected patients underwent the following: Full history taking and thorough physical examination, complete blood picture, liver and kidney function tests and abdominal CT. Also, ERCP was performed whenever needed and the tumor markers, alpha feto-protein & (CA 19-9) were assessed in selected cases when mass lesions were detected. Results : The frequency of cholestatic liver diseases presented with elevated both ALP & GGT as described above, was %19.7 (100 of 506 patients).While the frequency of extrahepatic cholestasis was 12.1% with females accounting for 54.1% and males were 45.9% with mean ages SD of 51.1 11.7 years. Benign causes of surgical obstructive jaundice were more frequent than malignant ones (57.4% VS 42.6%). The most common cause was choledocholithiasis in 25/61 (40.9%), followed by cancer head of pancreas 9/61 (14.8%), peri-ampullary carcinoma 8/61 (13.11%), cholangiocarcinoma 5/61 (8.2%) and pancreatitis 4/61 (6.6%). Dark urine, clay stool and itching were more common in patients with malignant obstructive jaundice. There was a highly positive agreement between ALP and GGT with P Conclusion : We concluded that, the frequency of cholestatic liver diseases in our department was %19.7. Among them, extrahepatic causes had a frequency of 12.1% with choledocholithiasis as the commonest benign etiology, while cancer head of pancreas was the most frequently met with malignancy. ERCP is considered the gold standard modality in diagnosis and management of extrahepatic cholestasis

Predictors of myocardial injury in patients with acute upper gastrointestinal bleeding

UPPER gastrointestinal bleeding (UGIB) is a common, potentially life-threatening condition. Myocardial injury may complicate UGIB. Previous studies were conducted to evaluate causes and consequences of UGIB after acute myocardial infarction (AMI). Acute MI adds additional risk to already critically ill patients of UGIB and markedly worsens their prognosis. However, little data are known about the prediction of MI in patients with acute UGIB. The aim of the work was to study the predictive risk factors for acute myocardial infarction in patients with acute upper gastrointestinal bleeding. One hundred and five patients with UGIB (67 males and 38 females) with mean age of 52.9 ± 9.3 years were enrolled in the study. Patients were excluded from the study if there was one or more of the following: age younger than 35 years, initial systolic blood pressure > 100 mmHg, initial hemoglobin ⩾ 12 gm/dl, history of previous ischemic heart disease, or contraindication for upper GIT endoscopy. All patients were submitted to full history taken and clinical examination, emergency upper gastrointestinal endoscopy, 12-leads electrocardiography (ECG), CK, CK-MB, Troponin I, complete blood picture, liver and kidney function tests, bleeding profile, arterial blood gases and electrolytes, lipid profile, fasting and postprandial blood glucose level, abdominal ultrasonography, and echocardiographic assessment. According to the presence of myocardial injury, patients were divided into two groups: Group I; included 66 patients without myocardial injur. Group II: included 39 patients with myocardial injury. Population characteristics were comparable in all groups. In patients with myocardial injury, there were significantly more hypertensive patients, more smokers, more patients with liver cirrhosis, and more patients with rebleeding than among those without myocardial injury. In patients with myocardial injury, mean body mass index, mean C-reactive protein, and mean hospital were significantly higher than in patients without myocardial injury. Logistic regression analysis showed that the most significant predictors for myocardial injury in descending order were: hypertension (score = 14.48, odd ratio = 7.057, p < 0.00001), cigarette smoking (score = 10.425, odd ratio = 5.425, p < 0.0001), liver cirrhosis (score = 7.845, odd ratio = 4.972, p = 0.0017), body mass index > 25 kg/m 2 (score = 7.132, odd ratio = 4.214, p = 0.0073), and C-reactive protein level > 5 mg/dl (score = 6.321, odd ratio = 3.986, p = 0.0159). Among patients with UGIB, patients with myocardial injury had significantly more incidence of hypertension, smoking, liver cirrhosis, and rebleeding than those without myocardial injury. Mean body mass index, mean C-reactive protein level, and mean hospital stay were significantly higher in patients with myocardial injury. The most significant predictors for myocardial injury in patients with UGIB in descending order were hypertension, cigarette smoking, liver cirrhosis, body mass index > 25 kg/m 2 , and C-reactive protein level > 5 mg/dl.

Assessment of interleukin 1β serum level in different responder groups and stages of chronic myeloid leukemia patients on imatinb mesylate therapy.

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence of an acquired mutation which affects the hematopoietic stem cell, leading to a striking overproduction of immature granulocytes. The first important clue to its pathogenesis the Philadelphia chromosome created by a reciprocal translocation between chromosomes 9 and 22 (t [9; 22] [q34; q11]). The development of the BCR-ABL-targeted imatinib mesylate represents a paradigm shift in the treatment of CML. Imatinib displays inhibitory activity against other kinase(s) that play a role in monocyte/macrophage development. Accordingly many studies revealed the role of cytokines in pathophysiology of myeloid neoplasia including participation of IL-1β in the pathogenesis of CML. This study designed to assess the behavior of IL-1β through newly diagnosed patients, different responders groups (optimal, suboptimal and failure cytogenetic response) and advanced stages (acceleration and crisis groups) of CML Iraqi patients whom receiving Imatinib mesylate (tyrosine kinase inhibitor), trying to elucidate the role of immunity in pathophysiology of CML disease development and treatments. In this study 96 Iraqi CML patients under imatinib mesylate treatment categorized by complete blood picture and fluorescent in situ hybridization analysis into different response groups and stages, then used an enzyme linked immunosorbent assay technique to assess serum level of IL-1β in each response group and advance stage (acceleration and transformed) of CML patients, in comparison to level in 32 healthy control subjects and 32 newly diagnosed CML. Out of 128 patients the mean serum of interleukin 1β level (pg/ml) for the newly diagnosed, optimal responded, suboptimal responded, failure cytogenetic and advance stage of CML were 6.53±3.81, 18.47±4.29, 18.69±3.03, 5.73±2.44, and 18.10±3.10, respectively. While healthy was 12.17±3.44. The measurement of IL-1β before and during treatment of CML patients may contribute to the early identification of responder and non responder patients, and help in the earlier choice and/or design of alternative therapeutic strategies.

English

AIM: To evaluate resistive index in various stages of liver cirrhosis and to determine its significance in developing hepatorenal syndrome. METHODS: Study included 60 cirrhotic patients divided into 4 groups (15 patients each): compensated liver cirrhosis (group A), diuretic responsive ascites (group B), refractory ascites (group C), hepatorenal syndrome (group D) and ten healthy persons as control group (E). All patients subjected to detailed history taking and clinical examination. Laboratory investigations included simple urine analysis, complete blood picture, liver function tests, blood urea and serum creatinine, serum sodium and serum potassium, and protein concentration. Ultrasonographic examination and renal duplex Doppler were under taken to assess the Resistive index. RESULTS: The RI of interlobar and arcuate arteries were significantly higher in all patient groups than in control group (p <0.05), the RI was significantly higher in patients with refractory ascites than in patients with diuretic responsive ascites, and also in patient of diuretic responsible ascites than in patients with compensated cirrhosis (p < 0.05), in patient with hepatorenal syndrome than in patient with diuretic responsive ascites and patients with compensated cirrhosis (p<0.05). Also Creatinine levels & blood urea levels in patients with the hepatorenal syndrome was significantly higher than that of other different groups (p<0.05) but there was no significant change in creatinine levels between patients with compensated cirrhosis and control group. While creatinine levels in patient with diuretic responsive ascites was significantly higher than that in patient with compensated cirrhosis (p<0.05) there was no significant change between patient with diuretic responsive ascites and patient with refractory ascites. CONCLUSION: Resistive index increases with degree of hepatic decompensation. Renal duplex ultrasound is a non- invasive, simple and easy method to study intrarenal hemodynamics in patients with liver cirrhosis INTRODUCTION: Renal hemodynamic changes with intense intrarenal vasoconstriction begin early in the course of liver disease before changes in the level of serum urea and serum creatinine1. Patients with liver cirrhosis and portal hypertension develop circulatory dysfunction characterized by disturbance in systemic and renal hemodynamics. Hepatorenal syndrome (HRS) is a functional and reversible form of renal failure that occurs in patients with advanced chronic liver disease. The distinctive hallmark feature of HRS is the intense renal vasoconstriction caused by interactions between systemic and portal hemodynamics. This results in inactivation of vasoconstrictors and suppression of vasodilators in the renal circulation. Although the assessment of kidney function is of great clinical importance in patients with liver cirrhosis and ascites, serum creatinine and even

Impact of sevoflurane versus isoflurane on coagulation profile in living donor liver transplant recipients: a prospective randomized trial

Background End-stage liver disease is characterized by severe coagulopathy, and bleeding is common during liver transplantation (Ltx). Previous studies reported a depressant effect of some inhalational anesthetics on platelet function in normal patients. None of them investigated this effect in Ltx recipients with end-stage liver disease. In this study, we evaluated the effects of sevoflurane versus isoflurane on coagulation function, blood loss, and transfusion requirements in living donor liver transplantation recipients. Patients and methods A total of 32 patients of either sex, with MELD score between 12 and 18 scheduled for living donor liver transplantation, were randomly allocated into either the sevoflurane group ( N = 18) or the isoflurane group ( N = 14), based on the inhalational anesthetics used. Standard hemodynamic monitoring was applied. All operations were performed by the same anesthesia and surgery teams. All patients were administered propofol/fentanyl and rocuronium bromide for induction, followed by continuous infusion of fentanyl for analgesia and rocuronium bromide for muscle relaxation. Samples for INR, prothrombin time, bleeding time, Factor V, Factor VII, serum fibrinogen, complete blood picture, and aPTT were collected before the induction of anesthesia, end hepatectomy, 60 min after reperfusion, and 6, 12, 24 h in the ICU. Amounts of blood loss and blood components transfusion were also recorded at the end of operation and first postoperative day. Results Both the groups had comparable demographics, coagulation profiles, and MELD scores. Bleeding time was significantly longer in the sevoflurane group ( P = 0.04), starting at end hepatectomy and persisted till the sixth hour postoperative reading, compared with the isoflurane group. INR, aPTT, PT, Factor V and Factor VII, and Hg were comparable in both groups. Platelet count was also not significantly different between both groups. Blood loss and transfusion requirements were comparable in both groups. No outcome difference was observed between groups. Conclusion In Ltx recipients, sevoflurane induced prolongation of the bleeding time compared with the isoflurane group. Yet, no clinically significant impact was encountered regarding blood loss and transfusion requirements either during intraoperative or the early postoperative period.

Variable Manifestations of Severe Hypoprothrombinemia (Factor II Deficiency): 2 Cases

Case 1 is a 28 months female child, who has been symptomatic from 8 month of age with multiple, painful bruises over legs once in 5 to 6 weeks. Her complete blood picture was normal.PT and APTT were prolonged with normal fibrinogen and liver function. Case 2, became symptomatic from day 2 of life. He was treated for blood stained vomiting and black coloured stool and severe anaemia. Second episode was subdural hemorrhage and seizures. Investigations revealed abnormal PT and APTT with normal fibrinogen and liver function. Hereditary prothrombin deficiency is one of the rare congenital coagulation defect encountered in clinical practice. High index of suspicion is required to diagnose this condition with systematic approach as the facility to check factor 2 levels are not freely available in many centres. Bleeding manifestations are dependent on factor level. Children with severe deficiency are prone for life threatening bleeds. We report couple of children who had severe form of hereditary prothrombin deficiency with variable clinical manifestations. In both the cases, coagulation profile was suggestive of common pathway defect, PT and APTT were prolonged. Fibrinogen and Liver function tests were normal. No evidence of sepsis, no response to vitamin K. Further evaluation revealed low prothrombin activity (<1%). Factor v and x were normal.

Investigation of lipid profile and occular oxidative stress of Chloroxylon swietenia on Streptozotocin‑nicotinamide‑induced diabetic rats

Background: Diabetes mellitus is a chronic metabolic disorder, characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Aim: This investigation was designed to study the antidiabetic effect of Ethanolic extract of Chloroxylon swietenia (EECS) in Streptozotocin‑Nicotinamide‑induced type‑II diabetes in rats. Materials and Methods: The extract at doses of 250 and 500 mg/kg was given to the overnight‑fasted Wistar albino rats for 14 days and the antidiabetic, lipid profile and ocular oxidative stress in Streptozotocin‑Nicotinamide‑induced diabetic rats were evaluated. The parameters studied were blood glucose, lipid profile [total cholesterol (TC), triglyceride (TG), high‑density lipoprotein (HDL), low‑density lipoprotein (LDL) and very low‑density lipoprotein (VLDL)], serum enzymes such as serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), antioxidant enzymes like catalase (CAT), thiobarbituric acid reactive substances (TBARS), glutathione (GSH), complete blood picture (RBC, haemoglobin, WBC), insulin and liver glycogen levels. The result of test drug was compared with diabetic control. Glibenclamide (10 mg/kg) was selected as standard hypoglycaemic drug. Statistical Analysis: Results were expressed as Mean ± SD. Dunnet’s and one‑way ANOVA test was used to compare the mean values of test groups and diabetic control. Results: Administration of EECS prior to glucose overload resulted significant attenuation in blood sugar level at 60 and 120 min in comparison to glucose control group. The antidiabetic activity of EECS showed significant (P < 0.001) reduction in blood glucose level at 250 mg/kg and 500 mg/kg dose levels at 14th day. EECS with (250 and 500 mg/kg) also decreased in serum SGOT, SGPT, TG, TC, VLDL‑C, LDL‑C, WBC and TBARS, in diabetic‑induced rats. In addition EECS at (250 and 500 mg/kg) increased liver glycogen, insulin, complete blood picture RBC, haemoglobin, ocular oxidative enzymes CAT, GSH and body weight when compared with diabetic control. Conclusion: The result obtained from the present study revealed the potential anti‑diabetic activity of Ethanolic extract of Chloroxylon swietenia. Key words: Blood glucose, blood profile, Chloroxylon swietenia, diabetes mellitus, lipid profile, liver glycogen, ocular oxidative stress, serum insulin

Interleukin-17-producing CD4+T cells in patients with chronic hepatitis B

Objective Our aim is to evaluate the expression of interleukin-17-producing CD4 + T cells (Th17) in peripheral blood of patients with chronic hepatitis B (CHB) and whether these cells show a potential to exacerbate liver damage during chronic hepatitis B virus (HBV) infection. Background Interleukin-17-producing CD4 + T cells (Th17)-mediated immune response has been shown to play a critical role in inflammation-associated disease; however, its role in chronic HBV infection remains unknown. Here, we characterized peripheral Th17 cells and analyzed their association with liver injury in HBV-infected patients. Participants and methods This study included 15 patients with CHB without cirrhosis (11 men and four women), 15 patients with CHB with cirrhosis (eight men and seven women), and 15 healthy controls (10 men and five women). Laboratory investigations including complete blood picture, liver function tests, hepatitis viral markers (HBsAg, anti-HCV-Ab), a-fetoprotein, and HBV DNA PCR were performed for all participants. Evaluation of the level of Th17 cells in the peripheral blood was carried out using the flow cytometry technique. Results The data showed that the frequency of circulating Th17 cells was increased in patients with CHB viral infection compared with the healthy controls, and was significantly higher in patients with CHB-associated cirrhosis. In addition, the increasing levels of circulating Th17 cells were correlated positively with serum alanine transaminase levels. Conclusion Our results showed that Th17 cells were highly enriched in the peripheral blood of CHB patients, and their levels were related to disease progression, suggesting its role in exacerbation of liver damage during chronic HBV infection.

Cytotoxic T-lymphocyte antigen-4 gene polymorphisms in hepatocellular carcinoma patients in Egypt

ObjectiveOur objective is to examine the genotypes at rs231775 in the cytotoxic T-lymphocyte antigen 4 gene (CTLA4) in an Egyptian population to detect the association between this single-nucleotide polymorphism (SNP) and susceptibility to hepatocellular carcinoma (HCC).BackgroundCTLA-4 is an important negative regulator in immune response. Its polymorphism +49G>A (dbSNP: rs231775) has been linked to an increased risk of T-cell-mediated autoimmune diseases, infectious diseases, and even carcinomas.MethodsThis study included 30 HCC patients (26 men and four women) and 20 healthy controls (18 men and two women). Laboratory investigations including complete blood picture, liver function tests, serum a-fetoprotein, and hepatitis viral markers (HBsAg, anti-HCV-Ab) were performed for all participants. The CTLA4 polymorphism at rs231775 was genotyped using the TaqMan allelic discrimination Assay technique.ResultsThe data showed a higher frequency of the A/A genotype (40 vs. 10%) and the A allele (55 vs. 27.5%) in patient groups (HCC) compared with the healthy controls. Our results also indicated a statistically significant difference in CTLA4 rs231775 between HCC patients and healthy controls in the AA genotype and the A allele (P = 0.04, 0.012), respectively.ConclusionOur results suggested that the A/A genotype and the A allele of rs231775 increase the risk of developing HCC in an Egyptian population, whereas the G allele appeared to have a protective effect in developing HCC.

The effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients

PurposeThe aim of the study was to evaluate the effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients.Patients and methodsThirty cirrhotic patients were divided into the following groups: group I, comprising 15 patients who received a late-evening 300-cal, 15-g protein-containing snack daily for 15 days; and group II, comprising 15 patients who received a late-evening supplement of amino acids (branched and essential) containing 22-g protein daily for 15 days. All patients were subjected to full history taking, clinical examination, and pelviabdominal ultrasound. Liver function tests, complete blood picture analysis, and estimation of blood urea and serum creatinine, urinary nitrogen loss, urea concentration in both serum and urine, and nitrogen balance were performed for all patients.ResultsThere was a significant increase in the mean level of serum albumin and red blood cell counts. The mean nitrogen balance significantly increased in both groups but more in patients who received branched chain amino acid (BCAA) supplementation. The mean serum ammonia significantly decreased in group II patients who received a late-evening BCAA supplementation, but not in patients of group I who received a late-evening protein-containing snack. There was no statistically significant difference in the levels of serum bilirubin or fasting blood glucose in either group.ConclusionThe results of the present study suggest that late-evening snacking with either a small protein-containing meal or a BCAA supplement improves the level of alanine transaminase, aspartate aminotransferase, serum albumin, nitrogen balance, ammonia, urea, and the general condition of the patient. The patients receiving BCAAs respond better than the snack group. A BCAA mixture as a late-evening snack is a favorable nutritional intervention for liver cirrhosis patients to repair hypercatabolism and sarcopenia and improve their nutritional status, such as nitrogen balance and serum albumin. These results need to be further confirmed in a larger number of patients and for a longer period of time.

Study of the relation between diabetes mellitus and hepatic encephalopathy in patients with liver cirrhosis

Objective This study was designed to determine the role of diabetes mellitus (DM) in the pathogenesis of hepatic encephalopathy (HE) in patients with liver cirrhosis. Background DM and its complications may play a role in the mortality of hepatitis C virus (HCV)-related cirrhotic patients. DM is considered a comorbid disease in these patients and strict control of blood glucose level could improve survival in HCV-related cirrhosis. Patients and methods This study was carried out on 100 cirrhotic patients with DM [50 encephalopathic patients (group I) and 50 nonencephalopathic patients (group II)]. All patients in the study were subjected to a thorough assessment of history taking and thorough physical examination, laboratory investigations, including complete blood picture, liver function tests, liver, viral HBsAg and HCVAb, kidney function tests, serum sodium and potassium levels, abdominal ultrasonography, serum ammonia level, fasting and postprandial blood sugar levels, glycosylated hemoglobin (HbA1c) as well as tests to detect the presence of autonomic neuropathy (tilt-table test and diurnal variation of blood pressure measurements). Results The present study found a significant positive tilt-table test result and diurnal variation in blood pressure measurements in the encephalopathic group in comparison with the nonencephalopathic group, and a highly significant positive correlation between duration of DM and HbA1c levels when compared with grades of HE in the encephalopathic group. Conclusion Cirrhotic patients with longstanding and uncontrolled DM are more likely to have higher grades of HE. Autonomic neuropathy, which may complicate cirrhotic patients with longstanding uncontrolled diabetes, may play a role in the pathogenesis of HE in these patients.

Validity of Autotaxin as a Novel Diagnostic Marker for Liver Fibrosis in Egyptian Chronic HCV Patients

We aimed to detect the validity of serum ATX as a diagnostic marker for liver fibrosis. Forty-eight males and 16 females were enrolled in the current study. Their ages ranged from 29-57 years with mean of 45.09, all were chronically HCV infected. Laboratory assessment was done for all subjects in form of complete blood picture; liver function test; lipid profile and serum detection of ATX. Patients were grouped according to the stage of fibrosis into group 1: fibrosis score 0, 1, 2, 3; group 2: fibrosis score: 4, 5, 6.The mean values of ATX in all studied patients with chronic HCV infection was 63.02 ± 36.29 while that of healthy controls was 65.31 ± 12.24 without any significant difference. Surprisingly, mean values of ATX were higher among patients with group 1 but it did not reach the significant level. In each group of them, the differences between mean values of ATX among different grades of liver fibrosis were insignificant. It was also noticed that the mean values of ATX were higher among men than in women .It was concluded that Autotoxin might not be used as a useful diagnostic marker for liver fibrosis in Egyptian chronic HCV patients.

Validity of Autotaxin as a Novel Diagnostic Marker for Liver Fibrosis in Egyptian Chronic HCV Patients

We aimed to detect the validity of serum ATX as a diagnostic marker for liver fibrosis. Forty-eight males and 16 females were enrolled in the current study. Their ages ranged from 29-57 years with mean of 45.09, all were chronically HCV infected. Laboratory assessment was done for all subjects in form of complete blood picture; liver function test; lipid profile and serum detection of ATX. Patients were grouped according to the stage of fibrosis into group 1: fibrosis score 0, 1, 2, 3; group 2: fibrosis score: 4, 5, 6.The mean values of ATX in all studied patients with chronic HCV infection was 63.02 ± 36.29 while that of healthy controls was 65.31 ± 12.24 without any significant difference. Surprisingly, mean values of ATX were higher among patients with group 1 but it did not reach the significant level. In each group of them, the differences between mean values of ATX among different grades of liver fibrosis were insignificant. It was also noticed that the mean values of ATX were higher among men than in women .It was concluded that Autotoxin might not be used as a useful diagnostic marker for liver fibrosis in Egyptian chronic HCV patients.

Assessment of localized therapeutic effect for prolonged release biodegradable implants loaded with 5-Fluorouracil on rats with induced liver cancer

The objective of this research was to assess ability of biodegradable implantable 5-Fluorouracil dosage forms, to maximize the regional exposure of the drug while limiting its systemic toxicity in rats with induced liver cancer. Liver cancer was successfully induced in male Wistar rats using a selected protocol followed by surgical implantation of prepared 5-FU biodegradable implant. Rats were sacrificed at time intervals and the pooled blood used to perform the different tests and the implant was retrieved, and analyzed to calculate the amount of drug left in implant. The amount of 5-FU in blood was quantified using high pressure liquid chromatography (HPLC). Gross examination of rat liver, calculation of liver to body weight percentage, and complete blood picture analysis were also performed. Liver biopsies were examined to assess signs of liver necrosis. Localized necrotic areas were noted in rat liver biopsies after 5 days with a perimeter of 0.3 to 0.6 cm around the implants indicating the localized 5-FU therapeutic effect. Sustained drug release was detected in rats for about 2 months and the amount of 5-FU released from implant into the systemic circulation was found to represent less than 13%. PLA coated injection molded implants loaded with 5-FU could present a promising dosage form for liver cancer treatment.

Etiological and prognostic values of procalcitonin in hospital-acquired pneumonia

BackgroundBiological markers such as procalcitonin, may be helpful for the diagnosis of HAP. Procalcitonin has greater diagnostic accuracy than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein and ESR. The aim of the study was to assess the etiological and prognostic values of procalcitonin in adult patients with hospital acquired pneumonia (HAP). Methods15 Patients with a strong suspicion of hospital acquired pneumonia. The diagnosis of HAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. Complete blood picture, sputum culture and sensitivity, ESR, CRP and PCT were obtained at admission and repeated after 2weeks. PCT was determined with Elecsys BRAHMS PCT in serum of studied patients. ResultsSerum PCT above 0.5μg/L was considered highly positive for diagnosis of HAP. It was significantly higher at admission (2.72±1.72μg/L) than after two weeks (1.0±1.91μg/L). There was a statistical significant decrease in serum levels of procalcitonin (P=0.002) in response to antibiotic therapy. Also the PCT was significantly higher in patients with bad outcome (2.11–6.0μg/L) than patients with good outcome (1.76±0.69μg/L). Procalcitonin was significantly higher among patients with pseudomonas (5.53±0.50μg/L) and acinetobacter (2.67±0.49μg/L) and lesser among patients with Escherichia coli (1.38±0.06μg/L) and MRSA (1.09±0.13μg/L). ConclusionProcalcitonin was a good etiological and prognostic marker in hospital acquired pneumonia. PCT is the most specific biomarker and has a number of advantages over previous markers.

CD4+ CD25+ cells in type 1 diabetic patients with other autoimmune manifestations

The existence of multiple autoimmune disorders in diabetics may indicate underlying primary defects of immune regulation. The study aims at estimation of defects of CD4+ CD25+high cells among diabetic children with multiple autoimmune manifestations, and identification of disease characteristics in those children. Twenty-two cases with type 1 diabetes associated with other autoimmune diseases were recruited from the Diabetic Endocrine and Metabolic Pediatric Unit (DEMPU), Cairo University along with twenty-one normal subjects matched for age and sex as a control group. Their anthropometric measurements, diabetic profiles and glycemic control were recorded. Laboratory investigations included complete blood picture, glycosylated hemoglobin, antithyroid antibodies, celiac antibody panel and inflammatory bowel disease markers when indicated. Flow cytometric analysis of T-cell subpopulation was performed using anti-CD3, anti-CD4, anti-CD8, anti-CD25 monoclonal antibodies. Three cases revealed a proportion of CD4+ CD25+high below 0.1% and one case had zero counts. However, this observation did not mount to a significant statistical difference between the case and control groups neither in percentage nor absolute numbers. Significant statistical differences were observed between the case and the control groups regarding their height, weight centiles, as well as hemoglobin percentage, white cell counts and the absolute lymphocytic counts. We concluded that, derangements of CD4+ CD25+high cells may exist among diabetic children with multiple autoimmune manifestations indicating defects of immune controllers.