Distinct cytokine patterns in Occult Hepatitis C and Chronic Hepatitis C Virus Infection

Background & Aim: 
The immunopathogenesis of chronic hepatitis C virus (HCV) infection is a matter of great controversy. The imbalance of T-helper lymphocyte cell cytokine production was believed to play an important pathogenic role in chronic viral hepatitis. Occult hepatitis C infection is regarded as a new entity that should be considered when diagnosing patients with a liver disease of unknown origin. The aim of this study was to determine serum T-helper 1 and T-helper 2 cytokine production in patients with occult HCV infection and its role in pathogenesis versus chronic viral hepatitis C infection.

Methods: 
Serum levels of cytokines of T-helper 1 (IL-2, IFN-[gamma]) and T-helper 2 (IL-4) were measured in 27 patients with occult HCV infection and 50 patients with chronic hepatitis C infection.

Results: 
The levels of the T-helper 1 cytokines, IL-2 and IFN-[gamma], were highly and significantly increased in patients with chronic HCV infection as compared with occult HCV infection (p<0.001). The T-helper 2 cytokine IL-4 was highly and significantly increased in occult HCV infection as compared with chronic HCV infection (p<0.001). Necroinflammation (P<0.001) fibrosis (P<0.001) and cirrhosis (P =0.03) were significantly increased in chronic HCV than occult HCV. 

Conclusion: 
Patients with occult HCV infection exhibited distinct immunoregulatory cytokine patterns, favoring viral persistence in the liver in spite of its absence from peripheral blood and explaining the less aggressive course of this disease entity than chronic hepatitis C virus infection

Seroprevalences and local variation of human and livestock brucellosis in two villages in Gharbia Governorate, Egypt

This study aimed at assessing the epidemiology of brucellosis among both human and livestock populations in an endemic area in Egypt. A cross-sectional survey was conducted in two villages, where 616 inhabitants (aged 3-75 years) and 350 livestock of 97 households were enrolled. Sera were tested for Brucella spp. antibodies by tube agglutination test for both populations. Proportions of seropositive sera were 0.0 and 1.7% among the inhabitants, and 0.0 and 16% among livestock of villages I and II, respectively. Calculated seroprevalences considering the clustering of brucellosis within households were 0.03 for people and 5.2 for livestock in village II. The village variable (P = 0.07) and keeping sheep in the household (P = 0.01) were significant risk factors for human brucellosis, whereas only the village was significant for livestock (P < 0.001). Sheep showed the highest seropositive proportions of brucellosis among livestock. No association could be detected between human and livestock brucellosis. In conclusion, we found local variation of seroprevalences of brucellosis among human and livestock in the two surveyed villages. Further epidemiological studies have to be conducted in randomly selected governorates, not only to confirm the low seroprevelance of human brucellosis, but also to assess the risk factors of livestock infection for terms of prophylaxi

Increased α-Fetoprotein Predicts Steatosis among Patients with Chronic Hepatitis C Genotype 4

Background. The prognostic importance of α-fetoprotein (AFP) level elevation in patients with chronic hepatitis C and its clinical significance in steatosis associated with HCV infection remain to be determined. The present paper assessed clinical significance of elevated AFP in patients with CHC with and without steatosis. Methods. One hundred patients with CHC were divided into 50 patients with CHC and steatosis and 50 patients with CHC and no steatosis based on liver biopsy. Results. AFP was significantly increased in CHC with steatosis than patients without steatosis (P < 0.001). Highly significant positive correlation was found between serum AFP and necroinflammation as well as the severity of fibrosis/cirrhosis and negative significant correlation with albumin level in chronic HCV with steatosis (P < 0.001) but negative nonsignificant correlation with ALT and AST level (P ≤ 0.778 and 0.398), respectively. Highly significant increase was found in chronic hepatitis patients with steatosis than CHC without steatosis regarding necroinflammation as well as the severity of fibrosis/cirrhosis and AFP (P < 0.001). Conclusion. Patients with chronic HCV and steatosis have a higher AFP levels than those without steatosis. In chronic HCV with steatosis, elevated AFP levels correlated positively with HAI and negative significant correlation with albumin level

High Tone External Muscle Stimulation versus Aerobic Exercise on Endothelial Dysfunction and Walking Parameters in Peripheral Arterial Disease

Peripheral arterial disorder (PAD) is a common vascular disorder caused primarily by atherosclerosis, it leads to a decrease in blood flow in the legs. The theory of high tone external muscle stimulation (HTEMS) first in transmitting possibly the highest dose of energy into tissues by high frequency, and second by the resonance effect inducing oscillation of cellular and tissue structures improves cell metabolism, leading to analgesic, circulatory effects. The aim of the study was to investigate the effect of HTEMS on endothelial dysfunction and walking parameters in PAD. Methods: 60 diabetic patients with moderate stage PAD based on their ankle brachial pressure index (ABPI) which ranged from 0.4 to 0.7 with IC and their age ranged from 40 to 70 years , selected from an outpatient clinic of Vascular Medicine Department, Cairo University Hospitals, were assigned randomly into two groups A&B. Group (A) (HTEMS group) included 30 patients who received high tone external muscle stimulation performed for 60 minutes per session, 3 times per week, for 12 weeks, in addition to their medical treatment. Group (B) (Exercise group) included 30 patients who participated in supervised regular aerobic exercise training program on treadmill with moderate intensity, (score 12-14 on Borg scale for rate of perceived exertion) 40 minutes per session, 3 times per week, for 12 weeks in addition to their medical treatment. The endpoints of this study were nitric oxide (NO) and walking parameters which are claudication Pain distance (CPD), claudication pain time (CPT), Peak walking distance (PWD), Peak walking time (PWT). Results: comparing both groups post treatment revealed statically significant improvement in group A and B with no significant difference between them in all parameters, as the percent increase in CPD value in groups A and B was 108.46% and 112.78%, respectively, while it was 95.30% and 102.18% in CPT in group A and B respectively. The percent increase in PWD value in groups A and B was 90.36% and 91.31%, respectively, while it was 96.29% and 99.03%, in PDT in group A and B respectively. The percent increase in the NO mean value in groups A and B was 17.94% and 17.36%, respectively. Conclusion: HTEMS had positive influence in the improvement of walking capacity and endothelial function in patients with PAD. It might also be employed as an alternative modality to exercise training, especially for patients with PAD who cannot adhere to exercise training or where the exercise is contraindicate

Effect of Pilates Exercises on Cortisol Hormone and Blood Pressure Among Hypertensive Women

Background: Hypertension is a major risk factor for cardiovascular diseases such as stroke and coronary artery disease as well as causes mortality. The Pilates method is a conditioning program in hypertensive patients of the body and mind that is gaining in popularity and acceptance worldwide. Aim of Study: To determine the response of cortisol hormone level and blood pressure after Pilates exercise in hypertensive post-menopausal women. Methods: Sixty women participated in this study was selected from Belbies Central employees and outpatient clinic with age mean ± SD values in groups (A) and (B) were 52.83 ± 3.89 and 53.37 ± 3.66 years., respectively. All of them suffering from high blood pressure stage 2(systolic 140 or higher and diastolic 90 or higher), they took medications (beta blockers - vasodilator – diuretics) and postmenopausal form 1-5 years ago. The study design was pre-post study. Patients were assigned for 8weeks protocol into two groups: Group (A) received Pilates training exercises (bent knee, shoulder bridge, side kick front, side kick back, and single leg circle), while Group (B) received only anti-hypertensive medications. Group (A) performed 5 types of Pilates exercises per session for /3 sessions/ week/ 8 weeks. The outcome measures were blood pressure (systolic and diastolic), cortisol level, anticoagulant factors (prothrombin time (PT), partial prothrombin time (PTT)) and physical characteristic (weight, body mass index (BMI), and waist hip ratio) were evaluated at the baseline and the end of the study. Results: Pre- and post-treatment comparisons showed a statistically significant decrease of the measured variables in the group A (cortisol level 17.73%, systolic blood pressure 3.70%, Diastole blood pressure 5.01 %, partial prothrombin time 7.38%, where weight 2.92 %, Body mass index 2.98 %) and significant increase in prothrombin time 0.67 %. In group B cortisol level 10.48%, significant decrease in diastole blood pressure 1.73%, no significant increase in (prothrombin time 0.25%, Partial prothrombin time 0.28%, weight 0.64%, BMI 0.34%, waist hip ration 0.11%) as well as no significant decrease in systolic blood pressure 0.75

Effect of Endurance Training on Homocysteine Level in Elderly with Megaloblastic Anemia

Background: Vitamin B12 deficiency causes megaloblastic anemia and it’s a major contributor to hyper-homo- cysteinemia which have been linked to the risk of vascular disease, stroke, and dementia and are relatively common in elderly. Aim of Study: To investigate effect of endurance training program on homocysteine level in elderly patients with megaloblastic anemia. Methods: Sixty elderly patients suffered from megaloblastic anemia, participated in this study were selected randomly from out-patient clinic of internal medicine in Sers Ellyan hospital with age mean ± SD values in groups (A) and (B) were 68.23±2.74 and 67.83±2.19 years, respectively. The study design was pre-post study. Patients were assigned for 16 weeks protocol into two equal groups: Group (A) (study group): received selected endurance training 3 times a week for 16 weeks with controlled dietary vitamin B12 intake, while Group (B) (control group): received only B12 supplementation. The outcome measures were serum vitamins B12, total homocysteine (tHcy), mean corpuscle volume, 10MWT test and physical characteristic (weight and body mass index (BMI)) were evaluated at the baseline and the end of the study in both groups. Results: Pre- and post-treatment comparisons showed a statistically significant increase of the measured variables in the group A (serum B12 47.68%, 10MWT 40.86%) and significant decrease in MCV 15.62%, tHcy 28.93%. Group B showed a statist (serum B12 134.76%, 10MWT 8.33% and significant decrease in MCV 17.97% and tHcy 37.31%). There were significantly higher change differences in the study group regarding dietary B12 and 10MWT compared to the control group (P\u3c0.001 for all), a significantly lower change was observed in serum B12 and tHcy in the study group compared to the control group (P\u3c0.001 for all) and no significant difference was detected between the two groups in MCV change (P=0.122). Conclusion: Endurance training program improved homocysteine and vitamin B12 biomarkers but not as conventional therapy and significantly improved gait speed

Increased α-Fetoprotein Predicts Steatosis among Patients with Chronic Hepatitis C Genotype 4

Background. The prognostic importance of α-fetoprotein (AFP) level elevation in patients with chronic hepatitis C and its clinical significance in steatosis associated with HCV infection remain to be determined. The present paper assessed clinical significance of elevated AFP in patients with CHC with and without steatosis. Methods. One hundred patients with CHC were divided into 50 patients with CHC and steatosis and 50 patients with CHC and no steatosis based on liver biopsy. Results. AFP was significantly increased in CHC with steatosis than patients without steatosis (P &lt; 0.001). Highly significant positive correlation was found between serum AFP and necroinflammation as well as the severity of fibrosis/cirrhosis and negative significant correlation with albumin level in chronic HCV with steatosis (P &lt; 0.001) but negative nonsignificant correlation with ALT and AST level (P ≤ 0.778 and 0.398), respectively. Highly significant increase was found in chronic hepatitis patients with steatosis than CHC without steatosis regarding necroinflammation as well as the severity of fibrosis/cirrhosis and AFP (P &lt; 0.001). Conclusion. Patients with chronic HCV and steatosis have a higher AFP levels than those without steatosis. In chronic HCV with steatosis, elevated AFP levels correlated positively with HAI and negative significant correlation with albumin level

Rare Mucinous Colorectal Adenocarcinoma: Analysis of the Epidemiological Factors in Relation to Survival in Egyptian Patients

Colorectal carcinoma (CRC) is one of the leading causes of cancer related deaths; in Egypt it constitutes 6.5% of all cancers. Previous studies have shown conflicting results on clinicohistopathological features and survival of patients with colorectal mucinous (MA) and non-mucinous adenocarcinoma (NMA). To the best of our knowledge, this study is the first to investigate these features in Egypt. In this work, we studied tumor tissue specimens from 150 patients with colorectal MA and NMA who underwent radical surgery from Jan 2007 to Jan 2012 at Gastroenterology Centre, Mansoura University, Egypt. Their clinicohistopathological parameters and survival were analyzed using established statistical methodologies. Incidence of MA and its subtypes was much higher in Egypt than worldwide incidence. MA was significantly associated with younger age, more depth of invasion, lymph node metastasis, less microscopic abscess formation and less peri-tumoral lymphocytic response (Crohn-like response) than NMA. Both groups were not significantly different "among others" in other clinicopathological parameters including lymphovascular and perineural invasion, association with adenoma and schistosomiasis. Multivariate analyses for disease free and overall survival revealed that mucinous histology is an independent prognostic factor. Among several factors, only distant metastasis and presentation with recurrent disease were independent prognostic factors within MA patients. In conclusion, MA represents a distinct clinicopathological entity with worse survival than NMA. Distant metastasis and presentation with recurrent disease are independent prognostic factors. Further molecular investigations considering genetic features of MA will lead to drug development and better management

Risk Factors for Chronic Mastitis in Morocco and Egypt

Chronic mastitis is a prolonged inflammatory breast disease, and little is known about its etiology. We identified 85 cases and 112 controls from 5 hospitals in Morocco and Egypt. Cases were women with chronic mastitis (including periductal, lobular, granulomatous, lymphocytic, and duct ectasia with mastitis). Controls had benign breast disease, including fibroadenoma, benign phyllodes, and adenosis. Both groups were identified from histopathologically diagnosed patients from 2008 to 2011, frequency-matched on age. Patient interviews elicited demographic, reproductive, breastfeeding, and clinical histories. Cases had higher parity than controls (OR = 1.75, 1.62–1.90) and more reported history of contraception use (OR = 2.73, 2.07–3.61). Cases were less likely to report wearing a bra (OR = 0.56, 0.47–0.67) and less often used both breasts for breastfeeding (OR = 4.40, 3.39–5.72). Chronic mastitis cases were significantly less likely to be employed outside home (OR = 0.71, 0.60–0.84) and more likely to report mice in their households (OR = 1.63, 1.36–1.97). This is the largest case-control study reported to date on risk factors for chronic mastitis. Our study highlights distinct reproductive risk factors for the disease. Future studies should further explore these factors and the possible immunological and susceptibility predisposing conditions

EGFR, CD10 and proliferation marker Ki67 expression in ameloblastoma: possible role in local recurrence

<p>Abstract</p> <p>Background</p> <p>Ameloblastoma is an odontogenic neoplasm characterized by local invasiveness and tendency towards recurrence.</p> <p>Aims</p> <p>Studying the role played by EGFR, CD10 and Ki67 in the recurrence of ameloblastoma.</p> <p>Methods</p> <p>This study was carried out on 22 retrospective cases of mandibular ameloblastoma from the period from Jan 2002 to Jan 2008 with follow up period until Jan 2011 (3 to 8 years follow up peroid). Archival materials were obtained from pathology department, Mansoura university. Paraffin sections of tumor tissue from all cases were submitted for routine H&E stains and immunohistochemistry using EGFR, CD10 and Ki67 monoclonal antibodies. Statistical analysis using of clinical data for all patients, tumor type, EGFR, CD10 and Ki67 expression in relation to recurrence were evaluated.</p> <p>Results</p> <p>Among the 22 cases, 10 cases were males and 12 were females with sex ratio 1:1.2. Age ranged from 34 to 59 years old with a mean age 44.18 year. Five cases showed local recurrence within studied period and proved by biopsy. No statistically significant relation was found between local recurrence and patient age, tumor size, tumor type, EGFR expression. There was a significant relation between CD10 expression as well as Ki67 labelling index and recurrence (P value = 0.003, 0.000 respectively).</p> <p>Conclusion</p> <p>Evaluation of CD10 and Ki67 status together with conventional histological evaluation can help in providing more information about the biologic behavior of the tumor, while EGFR could be a target of an expanding class of anticancer therapies.</p> <p>Since ameloblastomas are EGFR-positive tumors, anti-EGFR agents could be considered to reduce the size of large tumors and to treat unresectable tumors that are in close proximity to vital structures.</p> <p>Virtual Slides</p> <p>The virtual slide(s) for this article can be found here:</p> <p><url>http://www.diagnosticpathology.diagnomx.eu/vs/1902106905645651</url></p