Assessment of serum CXCL9 and pentraxin 3 as novel markers for hepatocellular carcinoma in cirrhotic hepatitis C patients.

Aim of the study: Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver. It is also one of the world's most common cancers and an important leading cause of cancer mortality in many parts of the world. As a result, it is essential to look for efficient markers for early and accurate HCC diagnosis. CXCL9 and pentraxin 3 are involved in the pathway of many cancers. The aim of the study was to assess the value of serum CXCL9 and pentraxin 3 as diagnostic markers of HCC among cirrhotic hepatitis C virus (HCV) patients. Material and methods: The current study was conducted on 90 candidates divided into 3 groups: group I - 30 patients with HCV induced liver cirrhosis without HCC; group II - 30 patients with HCV induced liver cirrhosis with HCC; group III - 30 healthy subjects (control group). All candidates were subjected to detailed history taking and thorough clinical examination, laboratory investigations, serum CXCL9, serum pentraxin 3, ultrasound abdomen and CT triphasic liver in group III. Results: Serum CXCL9 and serum pentraxin 3 levels were significantly higher in group II than group I and significantly higher in group I than group III. Conclusions: Serum CXCL9 and serum pentraxin 3 could be utilized as diagnostic markers for HCC.

Patterns of Interstitial Lung Disease in Egyptian Patients with Systemic Sclerosis: Relation to Disease Parameters.

BACKGROUND: Pulmonary involvement is the most common leading cause of morbidity and mortality associated with systemic sclerosis. Therefore, identifying the various patterns of pulmonary affection is crucial in the clinical management of these patients. In the current study, we aim to investigate the patterns of interstitial lung disease (ILD) associated with SSc patients (SSc- ILD) and their relation to serologic markers and clinical parameters. METHODS: A cross-sectional study was undertaken on thirty-four adult SSc patients who met the 2013 ACR/EULAR criteria for SSc and Forty healthy controls of matched age and sex. The patients were subjected to history taking, clinical examination, skin assessment using the modified Rodnan Skin Score (mRSS), chest x-ray (CXR), pulmonary function test (PFTs), and high resolution computed tomography of the chest (HRCT). Routine laboratory tests were conducted in addition to immunologic tests and an enzyme-linked immunosorbent assay (ELISA) to determine the IL-33 level. RESULTS: ILD was found in 23 SSc patients (67.6%); 20 patients had diffuse type while 3 patients had limited type. Non-specific interstitial pneumonia (NSIP) was found in 56.5%, usual interstitial pneumonia (UIP) was found in 21.7%, pleuroparenchymal fibroelastosis (PPFE) was found in 8.7%, and organizing pneumonia (OP) with the mixed pattern was found in 13% of SSc patients. Additionally, the mean IL-33 level in SSc patients was 98±12.7 compared to 66.2±10.6 in the control group (p < 0.001), with ILD patients having a significantly higher level (101.7±13.4) than those without (90.4±6.2), and a strong positive correlation with mRSS. CONCLUSION: Even in asymptomatic patients with SSc, ILD is prevalent, with NSIP being the most common pattern. IL-33 could be considered a potential biomarker for predicting the presence of ILD in SSc patients.

Evaluation of Human Leucocyte Antigen Mediated Platelet Transfusion Refractoriness and Platelet Crossmatching Assay in Patients with Hematologic Disorders.

Objectives: Platelet refractoriness complicates the platelet transfusion, which is essential for managing thrombocytopenia in patients with hematological disorders. It is associated with adverse clinical outcomes and increased health care costs. We conducted a prospective study to determine the effectiveness of cross-matched compatible platelets in a group of patients refractory to platelets from random donors and to evaluate human leukocyte antigen (HLA)-mediated refractoriness. Methods: This prospective study was conducted on 40 patients with different hematological disorders requiring platelet transfusions who were refractory to random platelets and presented to the hematology unit of Alexandria's main university hospitals between May 2020 and March 2021. They received 60 ABO-compatible platelet transfusions, either leuco-reduced or random donor platelets, stored for no more than 72 hours. A solid-phase red cell adherence technique (SPRCA) was used for platelet crossmatching. The corrected count increment (CCI) was used to monitor the effectiveness of each platelet transfusion with a cut-off value of 5 × 103/µL at 1 hour and 2.5 × 103/µL at 24 hours. Anti-HLA antibodies were assessed using the enzyme-linked immunosorbent assay technique. Results: Out of 60 cross matches, 47 (78.3%) were compatible, and 13 (21.7%) were incompatible. Among 47 compatible results, 30 (63.8%) showed adequate CCI and 17 (36.2%) showed inadequate CCI at 1-hour post-transfusion. Among the incompatible results, 3 (23.1%) had adequate CCI and 10 (76.9%) had inadequate CCI. Significant improvements were found in the mean CCI when comparing cross-matched compatible platelets and incompatible platelets at 1hour or 24 hours (p=0.009 and p < 0.001, respectively). From the 40 studied patients, HLA alloimmunization was present in 18 patients (45.0%) and absent in the remaining 22 patients (55.0%). In the absence of HLA alloimmunization, patients showed significantly better responses at 1 hour and 24 hours (p =0.001 and p =0.015, respectively). There was better sensitivity of platelet crossmatching with random donor platelet concentrates than single donor platelet concentrates. Conclusions: Platelet crossmatching using SPRCA and HLA screening are effective and rapid tools for better management of patients' refractory to platelet transfusions.

Hyperimmunoglobulinemia and IgG Subclass Abnormalities in Children With Gaucher Disease.

Gaucher disease (GD) is the most common lysosomal storage disorder, the aim of the current study was to investigate hyperimmunoglobulinemia and abnormalities of serum immunoglobulin G (IgG) subclasses in children with GD and the relation of those findings to the GD phenotype and genotype, duration of enzyme replacement therapy (ERT), and infection frequency. The study included 20 Egyptian children with GD receiving ERT and 20 age-matched and sex-matched healthy children as controls. Serum Ig and serum IgG subclass levels were measured in the children with GD. Serum IgG subclass levels were measured in the control subjects. Hyperimmunoglobulinemia was present in 15 of the 20 (75%) children with GD. In addition, it is found significantly lower IgG2 levels and significantly higher IgG3 levels in the GD group than in the control group (P<0.001 and <0.006, respectively). Patients with 12 infections per year had significantly higher IgG3 levels compared with patients with 6 infections per year (P=0.022). In conclusion, hyperimmunoglobulinemia and IgG subclass abnormalities occur in children with GD who are on ERT and may be related to recurrent infections.

Association of genetic polymorphism -670A>G in the Fas gene and serum markers AST platelet ratio index, AST/ALT with significant fibrosis and cirrhosis in chronic hepatitis C.

AIM: This study was carried out to evaluate the association of genetic polymorphism -670A>G in the promoter of Fas gene as well as serum biomarkers aspartate aminotransferase (AST) platelet ratio index (APRI) and AST/alanine aminotransferase (ALT) with significant fibrosis and cirrhosis in chronic hepatitis C patients. Seventy-nine patients with chronic hepatitis C in addition to 80 age- and sex-matched healthy controls were evaluated for genetic polymorphism -670A>G of Fas gene by polymerase chain reaction-restriction fragment length polymorphism and serum biomarkers APRI and AST/ALT in relation to significant fibrosis and cirrhosis diagnosed by liver biopsy. RESULT: Genetic polymorphism -670A>G in Fas gene was associated with significant liver fibrosis and cirrhosis. Heterozygous mutation was found in 11.4% of patients and 10% of controls, while homozygous mutation was found only in 7.6% of patients. Odds ratio (OR) was statistically not significant (OR=1.93, 95% confidence interval=0.76-4.92). Mean values of APRI and AST/ALT were significantly higher in patients with (F3-F4) compared with those with (F0-F2). (p-value <0.001 for APRI and p=0.007 for AST/ALT). In addition, APRI showed a better sensitivity than AST/ALT for prediction of significant fibrosis. CONCLUSION: Genetic polymorphism -670A>G of Fas gene was associated with significant fibrosis and cirrhosis in chronic hepatitis C patients. APRI and AST/ALT are independent predictors for significant fibrosis. APRI showed a better sensitivity than AST/ALT for prediction of significant fibrosis. Moreover, APRI can be used as an index to exclude liver cirrhosis without performing liver biopsy.

Coagulation abnormalities in type 1 Gaucher disease in children.

Gaucher disease is the most prevalent inherited lysosomal storage disorder caused by deficiency of beta-glucocerebrosidase enzyme. Clinically, 3 forms of Gaucher disease are recognized, of which type 1 is the mild to moderately severe, slowly progressive, nonneuropathic form. Bleeding disorders in Gaucher disease are believed to be due to thrombocytopenia but there may be additional factors that influence coagulation and fibrinolysis in Gaucher disease patients. The aim of the present work was to study some coagulation parameters in the Egyptian children with type 1 Gaucher disease. Five newly diagnosed patients and another 5 patients on enzyme replacement therapy (ERT) were enrolled in the study. Their coagulation profile, including coagulation factors, was evaluated. The results showed that in newly diagnosed cases factors II and VII were deficient in 40%, factor V was deficient in 20%, and all the cases had low levels of serum fibrinogen. In patients on ERT, factors VII and VIII were deficient in 60%, factor XI was deficient in 40% and factors V, X, and XII were deficient in 20% of cases. In conclusion, Egyptian patients with type 1 Gaucher disease, whether newly diagnosed or receiving enzyme replacement therapy, experience coagulation factor abnormalities regardless the clinical expression of bleeding diathesis. This should be taken into consideration before these patients are subjected to surgery for, e.g., splenectomy, which is common in these patients.

The use of mitomycin-C for respiratory papillomas: clinical, histologic and biochemical correlation.

OBJECTIVE: To assess the clinical effects of mitomycin-C (MMC) on human papilloma virus (HPV)-infected tissues of the airway. METHODS: We included 10 patients with previous histologic diagnosis of recurrent respiratory papillomas (RRP) in this prospective study, conducted at the Department of Otolaryngology-Head and Neck Surgery, University of Alexandria, Egypt, between January 2000 and December 2002. Under general anesthesia, each patient underwent laser excision of all visible papillomas, followed by topical application of 1 cc of 0.5 mg/ml MMC. The procedure was repeated weekly until no visible papillomas could be microscopically detected. We histopathologically studied the obtained specimens and tested for the presence of HPV DNA using polymerase chain reaction (PCR) technique. We collected blood samples from all patients and from another 10 healthy volunteers for determination of serum interleukin-2 (IL-2) level using enzyme-linked immunosorbent assay technique. RESULTS: We achieved clinical remission in 8 of the patients (80%), a fact that was confirmed histopathologically and by PCR data. The mean serum IL-2 levels+/- SD was significantly lower in papilloma patients (83.6+/- 28.83 pg/ml) than in control subjects (196.3+/- 42.46 pg/ml) (p<0.01). Among patients with RRP, serum IL-2 levels+/-SD was lower in initial samples (83.6+/- 28.83) than follow-up (95.7+/- 27.98 and 112.3+/- 33.8 and 129.4+/- 34.04) and remission samples (154+/- 37.84 pg/ml) CONCLUSION: Our result suggests that topical application of MMC may act adjunctively to laser surgery for RRP.