Apelin Association with Hepatic Fibrosis and Esophageal Varices in Patients with Chronic Hepatitis C Virus.

Portal hypertension and esophageal varices complicating hepatitis C virus (HCV)-related chronic liver diseases are some of the most devastating sequelae. Angiogenesis is the hallmark of their pathogenesis. Apelin is one of the recently identified angiogenic and fibrogenic peptides. We studied apelin gene expression, apelin (rs3761581) single-nucleotide polymorphism (SNP), and serum apelin level in patients with chronic HCV, and their association with liver fibrosis and esophageal varices in 112 patients with HCV-related chronic liver disease (40 with liver cirrhosis [LC]/low-grade varices, 33 with LC/high-grade varices, and 39 with fibrotic non-cirrhotic liver/no varices) and 80 healthy control subjects. Real-time polymerase chain reaction was used for apelin gene expression assay and apelin rs3761581 SNP analysis in peripheral blood samples. The serum apelin level was measured by ELISA. Apelin gene expression was undetectable in the studied samples. The SNP analysis revealed a greater frequency of the C (mutant) allele among patients compared with control subjects (P = 0.012; odds ratio, 3.67). The serum apelin level was significantly greater in patients with LC/varices (median, 31.6 ng/L) compared with patients without LC/varices (median, 2.9 ng/L; P < 0.001). A serum apelin level cutoff value of 16.55 ng/L predicted the presence of varices, with an area under the receiver operating characteristic curve value of 0.786. A positive correlation was found between serum apelin level and grade of liver fibrosis (r = 0.346, P < 0.001) and portal hypertension (r = 0.438, P < 0.001). In conclusion, the apelin rs3761581-C allele may be associated with the progression of HCV-related chronic liver disease and varices formation, and can be considered a potential therapeutic target to control fibrosis progression. The serum apelin level provided an accurate prediction of the presence of esophageal varices.

Interplay between vitamin D status and antiviral therapy among chronic hepatitis C Egyptian patients.

Vitamin D has been shown to play an important immunomodulatory role; deficiency of vitamin D has been recently associated to the lack of response to antiviral therapy in chronic hepatitis C patients. This study evaluated the interrelationship between serum level of vitamin D and early response to antiviral therapy in Egyptian patients with chronic HCV infection. A total of 45 patients with chronic HCV infection who received antiviral treatment (Pegylated interferon and Ribavirin), their vitamin D serum level was assessed once at the start of treatment and 12 weeks later, when the EVR was determine by Quantitative HCV-RNA by PCR. The results showed that vitamin D status has no correlation with viral load and hepatitis activity by biopsy and without significant association between vitamin D deficiency and the antiviral therapy response. However, there was significance improvement in level of vitamin D after 12 weeks of receiving the antiviral therapy of HCV.

Neuropathies in hepatitis C-related liver cirrhosis.

INTRODUCTION: Neurological complications occur in a large number of patients with chronic hepatitis C virus (HCV) infection and range from peripheral neuropathy to cognitive impairment. We studied the association between neuropathy and HCV-related chronic liver disease. METHOD: Fifty patients with HCV-related chronic liver disease were enrolled in this prospective case-control study. Patients were classified into two groups: mild and severe corresponding to a model for end-stage liver disease (MELD) score <14 and a MELD score >14, respectively. Complete neurological examination and nerve conduction studies have been done for all patients. All patients in addition to 25 healthy control subjects were tested for their serum B12 levels. RESULTS: Twenty-two percent of patients had sensory abnormality, 18 % had motor abnormality, while 10 % had both sensory and motor abnormalities. Autonomic function tests and nerve conduction studies revealed that 23 patients (46 %) had evidence of neuropathy and 10 patients (20 %) had both peripheral and autonomic neuropathy. Neuropathies were not related to the severity of the liver disease. Serum B12 level had a very wide range among patients with no relation between its level and neuropathy. Vitamin B12 level was significantly and directly correlated to MELD score and age. CONCLUSION: Peripheral and autonomic neuropathy has high prevalence in patients with HCV-related chronic liver disease. On the other hand, vitamin B12 level is high in those patients and there is no role for vitamin B12 in the liver cirrhosis-related neuropathy.

Role of cerebrospinal fluid IL-8 as a marker for differentiation between acute bacterial and aseptic meningitis.

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis (ABM) from aseptic meningitis (AM). A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones (p < 0.05). The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6 ng/ml with a sensitivity of 82.5% and a specificity of 85.0%.