prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

Background and study aims: the clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome [IBS]. The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS [according to Rome III criteria]

Patients and methods: this study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS [fulfilling Rome III criteria]. They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody [anti-tTG] test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy sample collected from the second part of the duodenum

Results: all of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients [8%] exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two group: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain [p>0.05]. The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients [p<0.01], as was the Na level in anti-tTG-negative patients [p<0.05]. A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protien and serum albumin

Conclusion: some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients

Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

A simple noninvasive test that accurately distinguishes NASH from NAFL as well as determines the disease severity is urgently needed. Recently, it was found that determination of Cytokeratin-18 [CK-18] fragments in the blood, predicts and correlates with histological NASH in which there is development of lobular inflammation, cell ballooning and fibrosis, supporting its usefulness in clinical practice To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. 90 subjects were divided into 3 groups: group I: including 30 patients with NASH, group II: including 30 patients with NAFL, and group III: including 30 healthy subjects as control. Diagnosis of NASH and its discrimination from NAFL was done by liver biopsy. CK-18 level in plasma was measured for all subjects using ELISA. CK-18 was significantly elevated in patients of group I in comparison to group II and III patients, with mean +/- SD: 460 +/- 279, 167 +/- 56 and 149 +/- 57, respectively, and/3 value: 0.001. The [ROC] curve diagnostic performance of CK18 in diagnosis of NASH shows: cutoff value of >240U/L, with sensitivity 76.7%, specificity 95.0%. Ck-18 was found to correlate with disease severity assessed by NAS scoring system with P value: 0.001. Measurement of CK18 in NASH is a useful screening, diagnostic and staging bio-marker

Cognutuve and neurological complications of bacterial meningitis in adult patients: a hospital based study

Bacterial meningitis is associated with disabling sequelae in a significant proportion of patients. It is associated with high mortality, risk of neuropsychological sequelae and risk of cognitive impairment the purpose of this study is to assess cognitive and neurological complications in adult patients with bacterial meningitis. A total of 45 patients with bacterial meningitis and 16 patients with tuberculous meningitis were enrolled. They were subjected to full medical history taking and clinical examination, full neurological examination on admission and discharge. Mini mental state examination [MMSE] and Wechsler memory scale [WMS] were used to assess cognitive function. The results showed that the ischemic brain insult [87.88%] followed by cranial nerves affection [32.42%] were the commonest neurological complication detected on discharge. Cognitive impairment was detected in 53.66% of patients using MMSE.WMS showed that orientation, information and logical memory were the most common affected. Cognitive and neurological complications were not statistically related to age or etiology [P>0.05]. Longer duration until diagnosis [Beta = -.18, p <0.001], presence of intracranial complications [Beta = -.12, p <0.005], need for mechanical ventilation [Beta = -.79, p <0.001] and drug abuse [Beta = -0.11, p < 0.05] were significant predictors of worse outcome assessed by Glasgow outcome score

Comparison between accuracy of different scoring systems in prediction of liver cirrhosis-related complications

Background: Many scoring systems have been widely applied in recent years for assessing and predicting the mortality across a broad spectrum of liver diseases. The two most commonly used prognostic models are the Child-Turcotte-Pugh score and the more recently described the model of end-stage liver disease [MELD] score and its derivatives

Aim of the work: The main objective of this work was to evaluate and compare the accuracy of the Child-Pugh score, the MELD score, and the new scores, MELD-Na, the integrated MELD [iMELD], and the MELD-to-sodium [MESO] index in the prediction of liver cirrhosis complications

Patients and methods: This study was conducted on 60 patients with chronic liver disease. They were divided into two groups: group I consisted of 17 [28.3%] patients with uncomplicated liver cirrhosis. They were 10 [58.8%] male and seven [41.1%] female patients. Their mean age was 58.7 +/- 10.7 years. Group II consisted of 43 [71.7%] patients with liver cirrhosis-related complications. They were 37 [86%] male and six [13.9%] female patients. Their mean age was 55.1 +/- 6.38 years. All were recruited from the Internal Medicine and Hepatology Department in Ain Shams University Hospitals. They were subjected to full medical history, clinical examination, lab investigations, upper gastrointestinal endoscopy, and imaging studies to assess the state of the liver disease and its complications. The MELD, its derivatives, and the Child-Turcotte-Pugh score were calculated for assessing their prognostic accuracy in relation to complications of chronic liver disease

Results: In this study, the most common complication was portal hypertension [70%], which is the leading cause for ascites and hematemesis due to esophageal varices. In this study, there was a highly significant statistical difference between group I and group II regarding albumin and International normalization ratio and a significant statistical difference between group I and group II regarding total bilirubin, platelets, and the sodium level [Na]. In this study, there was also a highly significant statistical difference between group I and group II regarding Child, MELD, MELD-Na, MESO index, and iMELD scores. Regarding the comparison between Child, MELD, MELD-Na, MESO index, and iMELD scores as predictors for liver cirrhosis complications, our study showed that the Child-Pugh score was the most sensitive score with the highest predictive accuracy. The Child score at a cutoff greater than 7.5 has a sensitivity of 97.7%, a specificity of 70.6%, and an accuracy of 0.95 in predicting the occurrence of complications. MELD at a cutoff greater than 12.5 has a sensitivity of 93%, a specificity of 70.6%, and an accuracy of 0.913 in predicting the occurrence of complications. MELD-Na at a cutoff greater than 16 has a sensitivity of 90.7%, a specificity of 70.6%, and an accuracy of 0.867 in predicting the occurrence of complications. The MESO index at a cutoff greater than 0.95 has a sensitivity of 90.7%, a specificity of 70.6%, and an accuracy of 0.919 in predicting the occurrence of complications. iMELD at a cutoff greater than 30.6 has a sensitivity of 95.3%, a specificity of 41.2%, and an accuracy of 0.841 in predicting the occurrence of complications. For the detection of the most common complication, that is, esophageal varices, the MELD score was found to be the most specific, with a specificity of 100% and a sensitivity of 43% and the cutoff point greater than 18. This was followed by the MESO index, with a specificity of 100% and a sensitivity of 39.2% and the cutoff point greater than 1.4, whereas other scores could not be significantly related to the prediction of such complications

Conclusion: This study concluded the superiority of the Child score over MELD, MELD-Na, MESO index, and iMELD scores in the prediction of liver cirrhosis-related complications, whereas the MELD score and the MESO index were the best for predicting the occurrence of esophageal varices

Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital

This prospective follow-up study was designed to analyze the causes and outcome of upper gastrointestinal bleeding among patients presenting by hematemesis and/or melena to Emergency Endoscopy Unit, Ain Shams University Hospitals. One thousand patients presented by upper GIT bleeding were subjected to complete clinical evaluation, emergency upper gastrointestinal endoscopy and therapeutic interventions as indicated. Follow up was done for occurrence of re-bleeding or mortality. Variceal causes of bleeding were the most common, representing 70.1% followed by non-variceal causes [26.1%] and obscure causes [3.8%]. Esophageal varices [EV] alone represented 17.8% of causes of variceal bleeding, while combined esophageal and gastric varices represented 39.5% and isolated gastric varices 12.8%. Gastric lesions were the most common causes of non variceal bleeding. Recurrence of bleeding occurred in 19.4% of variceal group in comparison to 6.1% of non variceal group, while mortality was found in 4.3% of variceal group in comparison to 1.5% of non variceal group with very highly significant difference [P <0.001]. Hypertension, ascites, EV columns, EV grade IV, presence of gastric varices and associated respiratory disorder were independent factors as-sociated with recurrence of bleeding in variceai group. In non variceal group, recurrence of bleeding was significantly related only to the presence of gastric ulcers [P=0.035]. Independent factors associated with mortality in studied patients were age, associated diabetes, presence of esophageal varices and associated duodenal ulcer

Molecular detection of circulating thyroid specific transcripts [TSHR/Tg-mRNAs] in thyroid cancer patients: their diagnostic significance

Thyroid cancer is the most prevalent endocrine malignancy. The preoperative diagnosis of differentiated thyroid cancer [DTC] that relies solely on fine-needle aspiration [FNAC] biopsy, sometimes possesses conflicting results. New molecular markers for thyroid cancer have been investigated with most of them based on the detection in thyroid nodules or tumor tissue specimens. Recently, it was possible to detect thyroid cancer cells in the circulation by measuring the mRNA of thyroid specific genes. Among these, thyroglobulin and more recently thyroid stimulating hormone receptor mRNAs, TSHR/Tg-mRNAs in peripheral blood might serve as cancer-specific markers. These have become promising new circulating markers for thyroid cancer. The purpose of this study is to assess TSHR/Tg-mRNAs as diagnostic molecular markers for thyroid cancer and if they can be used preoperatively in synergy with FNAC. This study was performed on 60 subjects; 20 healthy volunteers and 40 patients; including 16 patients with benign thyroid diseases, 24 patients with thyroid cancer; 18 patients with newly diagnosed [DTC] and 6 patients with recurrent thyroid cancer. Diagnosis of cancer was based on FNAC and histopathology of surgical specimens. All subjects had TSHR/Tg-mRNAs in peripheral blood measured by reverse transcriptase [RT]-PCR. Based on cytology/pathology; 18 patients had newly diagnosed DTC and 11 had benign thyroid disease. Preoperative FNAC was performed on 29 of 40 patients; FNAC was diagnostic in 11/18 of malignant lesions [61.1%], in 8/11 of benign lesions [72.7%], while 10/29 [34.5%] were indeterminate. TSHR/Tg-mRNAs correctly diagnosed DTC in 20/24 and 19/24 [sensitivity 83.3% and 79.1%] and benign disease in 14/16 and 13/16 [specificity 87.5% and 81.3%], respectively. With indeterminate FNA, TSHR/Tg-mRNAs correctly diagnosed DTC [follicular type] in 5/7 and benign disease in 2/3 [combined sensitivity 71.4%; specificity 66.7%]. There was high concordance between RT-PCR results for TSHR-mRNA and Tg-mRNA. Of the controls 19/20 [95%] and 16/20 [80%] were negative for both TSHR- and Tg-mRNAs. With the use of a carefully selected primer pair and qualitative RT-PCR; our results indicate that TSHR/Tg-mRNAs in peripheral blood are both equally sensitive and specific markers for detection of thyroid cancer cells. Combining TSHR/Tg-mRNAs and FNAC and ultrasound enhances the preoperative detection of cancer in patients with thyroid nodules, reducing unnecessary surgeries and correctly classified most follicular cancers and could have spared surgery in patients with benign disease

Salivary PCR detection of Helicobacter pylori DNA in Egyptian patients with dyspepsia

Several methods are available for detecting Helicobacter pylori infection: [1] invasive methods based on gastric biopsies, [2] non invasive methods like Urea Breath Test [UBT], serology and stool antigen tests. Importance of salivary PCR in detection of H. pylori is still questionable. To evaluate the role of salivary PCR technique in detecting H. pylori gastric affection in Egyptian patients with dyspepsia and in differentiating between functional dyspepsia and acid-ulcer syndrome. This study included 60 patients with dyspepsia classified into three groups: [Group 1] patients with gastric H. pylori and ulcers or erosions [n = 20], [Group 2] patients with gastric H. pylori and no ulcers or erosions and had functional dyspepsia [n = 20], [Group 3] patients without H. pylori and had functional dyspepsia [n = 20]. All underwent upper gastrointestinal endoscopy with biopsies, rapid urease test and salivary samples for H. pylori PCR. Significant difference between the three groups regarding salivary PCR values. No significant difference between Group 1 and Group 2 but both had significant difference with Group 3, significant difference between gastric H. pylori positive patients [n = 40] and negative ones [n = 20]. Salivary PCR test had sensitivity of 85%, specificity of 70% in diagnosing H. pylori. PCR value of 534000 Iu/ml had best sensitivity [75%] and specificity [100%] for diagnosing H. pylori, highly significant positive correlation between H. pylori gastric affection and salivary PCR values. No significant difference between patients with acid ulcer syndrome [n = 20] and those with functional dyspepsia [n = 40] as regard salivary PCR mean values. Salivary PCR test showed sensitivity of 100%, specificity of 50% in differentiating between patients with acid ulcer syndrome and those with functional dyspepsia. PCR value of 440000 Iu/ml had best sensitivity [100%] and specificity [55%] in differentiating acid ulcer syndrome from functional dyspepsia with non significant. H. pylori salivary PCR may be of value in diagnosing H. pylori gastric affection and is strongly correlated with it but it is of limited value in differentiating between acid ulcer syndrome and functional dyspepsia