Role of Vascular Endothelial Growth Factor-C during Stem Cell Therapy Using Autologous Bone Marrow Mononuclear Cells in Patients with Lower Limb Lymphedema

Introduction: Vascular endothelial growth factor-C (VEGF-C) is the primary lymphangiogenic factor that stimulates lymphangiogenesis by signaling via specific receptor, vascular endothelial growth factor receptor 3 (VEGFR3). This study was conducted to evaluate the change in the level of VEGF-C before and after autologous bone marrow mononuclear cell transplantation for treatment of Lower limb lymphedema. Patient and methods: Forty patients with lower limb lymphedema were divided into two groups. Group I included 20 patients with chronic lower limb lymphedema who underwent autologous bone marrow mononuclear cell transplantation. Group II included 20 patients with chronic lower limb lymphedema who were exposed only to compression therapy as a control group. VEGF-C level in the diseased limbs was measured in both groups at the beginning of the study then 3 and 6 months respectively. Results: Group I included 20 patients, 8 patients were male (40%) and 12 patients were females (60%) with mean age 29.5 ± 12.15 while group II included 20, 10 patients were male (50%) and 10 patients were females (50%) with mean age 39.5 ± 11.5. In group I, the specimens were taken at 3 and 6 months after transplantation showed a marked decrease in the VEGF-C level with statistically significant p value, 0.02 and 0.001 respectively. In group II the level of VEGF-C after compression therapy alone at 3 and 6 months interval showed fluctuation with statistically non-significant p value, 0.64 and 0.55 respectively. Conclusion: VEGF-C is essential for regulation of lymphangiogenesis. The level of VEGF-C was found elevated in patients with lymphedema and decrease after autologous mononuclear bone marrow cells, however these results were statically non-significant.

Relationship between vitamin D and IL-23,IL-17 and macrophage chemoattractant protein-1 as markers of fibrosis in hepatitis C virus Egyptians

AIM:To assess vitamin D in hepatitis C patients and its relationship to interleukin (IL)-23, IL-17, and macrophage chemoattractant protein-1 (MCP-1). METHODS:The study was conducted on 50 Egyptian hepatitis C virus (HCV) genotype number IV-infected patients and 25 ageand gender-matched healthy subjects. Venous blood samples were obtained. Samples were allowed to clot and sera were separated by centrifugation and stored at -20 ℃. A 25 hydroxy vitamin D assay was carried out using solid phase RIA. A 1,25 dihydroxy vitamin D assay was carried out using a commercial kit purchased from Incstar Corporation. IL-17 and -23 and MCP-1 were assayed by an enzyme immunoassay. Quantitative and qualitative polymerase chain reaction for HCV virus were done by TaqMan technology. Only HCV genotype IV-infected subjectswere included in the study. The mean ± SD were determined, a t-test for comparison of means of different parameters was used. Correlation analysis was done using Pearson's correlation. Differences among different groups were determined using the Kruskal-Wallis test. RESULTS:The mean vitamin D level in HCV patients (groupⅠ) was 15 ± 5.2 ng/mL while in control (group Ⅱ) was 39.7 ± 10.8. For active vitamin D in groupⅠas 16.6 ± 4.8 ng/mL while in group Ⅱ was 41.9 ± 7.9. IL-23 was 154 ± 97.8 in group Ⅰ and 6.7 ± 2.17 in group Ⅱ. IL-17 was 70.7 ± 72.5 in cases and 1.2 ± 0.4 in control. MCP-1 was 1582 ± 794.4 in group Ⅰand 216.1 ± 5.38 in group Ⅱ. Vitamin D deficiency affected 72% of HCV-infected patients and 0% of the control group. Vitamin D insufficiency existed in 28% of HCV-in-fected patients and 12% of the control group. One hundred percent of the cirrhotic patients and 40% of non cirrhotic HCV-infected patients had vitamin D deficiency. IL-23, IL-17, and MCP-1 were markedly increased in HCV-infected patients in comparison to controls.A significant negative correlation between vitamin D and IL-17 and-23 and MCP-1 was detected. HCV-infected males and females showed no differences with respect to viral load, vitamin D levels, IL-17, IL-23 and MCP-1. The viral load was negatively correlated with vitamin D and active vitamin D (P = 0.0001 and P = 0.001, respectively), while positively correlated with IL-23, IL-17, and MCP-1. We classified the patients according to sonar findings into four groups. Group Ⅰa with bright hepatomegaly and included 14 patients. Group Ⅰb with perihepatic fibrosis and included 11 patients. Group Ⅰc with liver cirrhosis and included 11 patients. Group Ⅰd with he patocellular carcinoma (HCC) and included 14 patients. Vitamin D and active vitamin D were shown to be lower in cirrhotic patients and much lower in patients with HCC, and this difference was highly significant (P = 0.0001). IL-17 and-23 and MCP-1 were higher in advanced liver disease) and the differences were highly significant (P = 0.0001).CONCLUSION:Whether the deficiency of vitamin D is related to HCV-induced chronic liver disease or predisposing factor for higher viral load is a matter of debate.

Distribution of HBV genotypes among HBV carriers in Benin:phylogenetic analysis and virological characteristics of HBV genotype E

AIM: To determine the distribution of Hepatitis B virus (HBV) genotypes in Benin, and to clarify the virological characteristics of the dominant genotype.METHODS: Among 500 blood donors in Benin, 21 HBsAg-positive donors were enrolled in the study. HBV genotypes were determined by enzyme immunoassay and restriction fragment length polymorphism. Complete genome sequences were determined by PCR and direct sequencing.RESULTS: HBV genotype E (HBV/E) was detected in 20/21 (95.2%), and HBV/A in 1/21 (4.8%). From the age-specific prevalence of HBeAg to anti-HBe seroconversion (SC) in 19 HBV/E subjects, SC was estimated to occur frequently in late teens in HBV/E.The comparison of four complete HBV/E genomes from HBeAg-positive subjects in this study and five HBV/E sequences recruited from the database revealed that HBV/E was distributed throughout West Africa with very low genetic divers ity (nucleotide homology 96.7-99.2%).Based on the sequences in the basic core promoter (BCP)to precore region of the nine HBV/E isolates compared to those of the other genotypes, a nucleotide substitution in the BCP, G1757A, was observed in HBV/E.CONCLUSION: HBV/E is predominant in the Republic of Benin, and SC is estimated to occur in late teens in HBV/E. The specific nucleotide substitution G1757A in BCP, which might influence the virological characteristics,is observed in HBV/E.

The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients

Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.

Macrophage Inflammatory Protein-1 Beta (MIP-1<i>β</i>) and Platelet Indices as Predictors of Spontaneous Bacterial Peritonitis<br>—MIP, MPV and PDW in SBP

Background/Aims: The objective of this study is to measure macrophage inflammatory protein one beta (MIP-1β), mean platelet volume (MPV) and platelet distribution width (PDW) to evaluate their usefulness in the diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Materials and Methods: This study comprised 41 cirrhotic patients with ascites. MPV, PDW and MIP-1β were measured in serum and ascitic fluid. Results: A significant increase MPV, PDW, C-reactive Protein (CRP) and white blood cell was observed in SBP group compared to non SBP (P ≤ 0.001, P = 0 β was significantly in-creased in ascitic fluid in patients with SBP versus non SBP (P ≤ 0.001). At cutoff value of 8.3 fl MPV had 85.7% sensitivity and 75% specificity (AUC = 0.876) for diagnosis of SBP. At cutoff value of 15.4 PDW had 90.4% sensitivity and 55% specificity (AUC = 0.762). At cutoff value of 121.9 pg/ml MIP-1β in ascitic fluid had 76.1% sensitivity and 100% specificity (AUC = 0.881) for detecting SBP. Conclusion: MIP-1β and platelet indices are useful marker in the diagnosis of SBP in cirrhotic patients. Combined measurement of MIP-1β in serum and ascitic fluid had 100% sensitivity and specificity for diagnosis of SBP.

The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes

Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and <0.0001 respectively). Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising in diagnosis of PROM & especially in those cases of suspected PROM and it should be done as a worse trial in every case of suspected PROM. Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Also they were more accurate than β-HCG and they can be used if PAMG-1 is not available for detection of doubtful PROM cases.

Ability of Comprehensive Geriatric Assessment to Detect Frailty

Background and Aim of the Work: Frailty is a state of reduced physiological reserve associated with increased susceptibility to disability. It is associated with a high morbidity and mortality. This work assessed the ability of comprehensive geriatric assessment to detect frailty in elderly patients. Subjects and Methods: A total number of 104 elderly patients (above 60 years old) were included in this study and they were subjected to a comprehensive geriatric assessment (CGA) including: (history and full clinical examination, Mini mental status examination (MMSE), Geriatric depression scale (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL). The patients were divided into frail and non-frail groups using Fried’s criteria as applied by Avila-Funes et al., 2008, each group included 52 patients. Results: There were no significant differences between the two groups regarding age gender or smoking habits. But there was higher percentage of ADL, IADL dependence in addition to higher incidence of depression and cognitive impairment among frail cases. Conclusion: Comprehensive geriatric assessment can be used to detect frailty and its associated impairment and comorbidities.

Presepsin and Procalcitonin as Potential Biomarkers for Early Diagnosis and Prognosis of Sepsis in Critically Ill Patients

Background: Sepsis has a poor prognosis for critically ill patients, even with intensive management. Early diagnosis of sepsis and detection of patients with worsening prognosis are important for immediate intervention to improve the clinical outcome. Objective: To investigate serum presepsin (PS) and procalcitonin (PCT) as early diagnostic and prognostic biomarkers for sepsis in critically ill patients. Methods: 60 critically ill patients with sepsis were subdivided into three groups of sepsis, severe sepsis and septic shock according to Acute Physiology and Chronic Health Evaluation II (APACHEII) and quick Sequential Organ Failure Assessment (qSOFA) scores. Patients were compared with 20 age and sex matched controls. Serum PS and PCT were measured by enzyme linked immunosorbent assay (ELISA). Results: Serum PS and PCT levels were significantly increased in septic patients than controls, and their increase was positively correlated with progression of sepsis severity till reached the highest levels in septic shock. Receiver operating characteristic (ROC) curve for predicting sepsis revealed that PS has the highest area under curve (AUC) (0.967) with 97.5% sensitivity, 85% specificity and cut-off of >635.5 pg/mL, followed by PCT that has AUC (0.946), 97.5% sensitivity, 95% specificity and cut-off of >319.7 pg/mL. C-reactive protein (CRP) showed the lowest AUC (0.902) with 75% sensitivity, 100% specificity and cut-off of >7 mg/L. ROC curve for predicting septic shock showed that PS has the highest AUC (0.969) with 90% sensitivity, 97.5% specificity and cut-off of >5500.6 pg/mL, followed by CRP that has AUC (0.945), 90% sensitivity, 87.5% specificity and cut-off of >63 mg/L. PCT showed the lowest AUC (0.889) with 90% sensitivity, 97.5% specificity and cut-off of >822.1 pg/mL. Conclusions: Serum PS and PCT were promising biomarkers for early diagnosis and prognosis of sepsis in critically ill patients, but PS was superior to PCT.

Desensitization Efficacy by Sublingual Immunotherapy of Shrimps Extract in Asthmatic, Rhinitis and Urticaria Allergic Patients

RATIONALE: Crustaceans, such as shrimp, crab, crayfish and lobster, play important role in human nutrition;they also can be important causes of severe acute hypersensitivity reactions. For patients diagnosed with a crustacean allergy, strict avoidance is the only proven therapy, highlighting the need for more specific treatment. Our aim was to evaluate the efficacy and tolerance of sublingual shrimp immunotherapy in Egyptian patients allergic to shrimp. METHODS: This study was intended to help in diagnosis of shrimps allergen in 60 allergic patients (subdivided to 3 groups Urticaria (G1), rhinitis (G2) & asthma (G3)) and evaluate the sublingual immunotherapy by employing skin prick test, specific Immunoglobulin E, Total Immunoglobulin E, Immunoglobulin G, Eosinophilis and Peak Expiratory Flow Rate (PEFR), before and after therapy. Inclusion criteria were a history of shrimp allergy and positive skin prick test to crude shrimp extract from two species [Penaeus semisulcatus and Metapenaeus stebbingi] at allergy and clinical immunology unit, in-Shams Hospitals. They underwent immunotherapy with extract of shrimp species and administered sublingually (SLIT). The measurement of all latter investigations for shrimp allergen on the start and 6 months after immunotherapy, as compared to placebo control, were performed. Results: The clinical response and laboratory improvement of the patients was correlated with their decline in the eosinophils (p < 0.001), total Immunoglobulin E (p < 0.001) and specific Immunoglobulin E test (p < 0.001) and with their increased in PEFR (p < 0.001) and Immunoglobulin G (p < 0.001). This study suggests that the most desenstized responsed group was rhinitis group followed by Urticaria group. Also,The more effective season induce allergy in summer (48.3%) followed by springs (28.3%) and genatic predisposition of allergic diseases was highly accepted in patients had a family history (68%). In conclusion, sublingual immunotherapy for shrimp allergy was safe, simple, uncostly, well tolerated and efficacious, gave a good results especially in the treatment of patients with allergic rhinitis.

Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology

Background & objectives: Data regarding tumor marker usefulness in diagnosing ascites of unknown etiology and determining its malignant nature are conflicting. We aim to assess the diagnostic value of ascitic and serum tumor markers in ascites of unknown etiology and to evaluate their usefulness besides other laboratory tests in a diagnostic work-up in those patients. Design & setting: A prospective case-control study conducted at Assiut University hospital and oncology institute. Patients & Methods: Three groups were included;Group I: 41 patients with ascites of unknown etiology Group II: 7 Patients with TB ascites and Group III:14 patients with cirrhotic ascites. We assessed the CEA, CEA mRNA, CA15-3, CA19.9, CA125, AFP and PSA in serum and ascetic fluid. A diagnostic work-up for group I included: IPD test, ultrasound, CT, ascetic fluid cytology, SAAG, Laparotomy and biopsy. Results: Ascetic fluid and serum levels of CA15-3 and CA125 were significantly increased in group I and were significantly increased in histopathologically proved malignant ascites compared to TB and cirrhotic ascites. In group I, CA 125 was significantly higher in ascites than serum. With the exception of PSA, all tumor markers significantly correlated in serum and ascetic fluid. No significant difference in the level of ascetic CEA messenger RNA was detected between the 3 groups. Cytology had 53% sensitivity, 94% specificity and CA 125 & CA15-3 had 81% sensitivity and 75% specificity in detection of malignant ascites repectively. Laparotomy and biopsy: diagnosed malignnancy in 53.3% and TB in 13.3%. Conclusions: A diagnostic work-up including SAAG, tumor markers in the serum and ascetic fluid may help in adjunct with ascetic fluid cytology, laparotomy and biopsy, imag- ing and other laboratory tests in diagnosing ascites of unknown etiology.

Evaluation of Plasma Urokinase-Type Plasminogen Activator Receptor and Interleukin 34 in Patients with Chronic Hepatitis C as Serological Fibrosis Markers

Background: Hepatitis C Virus (HCV) infection is a progressive disease that may result in chronic hepatitis, fibrosis and cirrhosis. Assessment of liver fibrosis is an essential factor in the management of chronic HCV. Objective: To evaluate plasma soluble Urokinase Plasminogen Activator Receptor (sUPAR) and interleukin-34 (IL-34) as serological markers of liver fibrosis in patients with chronic HCV. Methods: This case-control study enrolled 60 chronic HCV patients who were subdivided into three groups of mild, moderate and severe hepatic fibrosis depending on Fibrosis-4 score (FIB-4). Patients were compared with 20 age and sex-matched controls. Plasma sUPAR and IL-34 levels were measured by Enzyme Linked Immunosorbent Assay (ELISA). Results: Plasma sUPAR and IL-34 were significantly increased in HCV patients when compared with controls, and their increase was positively correlated with the progression of hepatic fibrosis. Plasma sUPAR and IL-34 positively correlated with Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT), and negatively correlated with hemoglobin concentration and platelet count. The output data of Receiver Operating Characteristic (ROC) curve to differentiate patients from controls revealed that sUPAR at cut-off > 186.2 ng/L and Area Under Curve (AUC) of 0.944 had (85%) sensitivity and (100%) specificity, and IL-34 at cut off > 16.4 ng/L and AUC of 0.942 had (75%) sensitivity and (100%) specificity. The output data of ROC curve to differentiate severe from mild to moderate hepatic fibrosis patients revealed that sUPAR at cut-off > 510 ng/L and AUC of 0.837 had (80%) sensitivity and (90%) specificity. While IL-34 at cut off > 55.3 ng/L and AUC of 0.844 had (85%) sensitivity and (80%) specificity. Conclusions: Increased plasma levels of sUPAR and IL-34 in chronic HCV patients with liver fibrosis and their increase was parallel to the degree of liver fibrosis. Plasma sUPAR and IL-34 can be used as serological markers of liver fibrosis in chronic HCV patients.

Assessment of seminal plasma laminin in fertile and infertile men

Aim： To assess laminin levels in the seminal plasma of infertile and fertile men, and to analyze the correlation of laminin levels with sperm count, age, sperm motility and semen volume. Methods： One hundred and twenty-five recruited men were equally divided into five groups according to their sperm concentration and clinical examination： fertile normozoospermia, oligoasthenozoospermia, non-obstructive azoospermia （NOA）, obstructive azoospermia （OA） and congenital bilateral absent vas deferens （CBAVD）. The patients＇ medical history was investigated and patients underwent clinical examination, conventional semen analysis and estimation of seminal plasma laminin by radioimmunoassay. Results： Seminal plasma laminin levels of successive groups were： 2.82 ± 0.62, 2.49 ± 0.44, 1.77 ± 0.56, 1.72 ± 0.76, 1.35 ± 0.63 U/mL, respectively. The fertile normozoospermic group showed the highest concentration compared to all infertile groups with significant differences compared to azoospermic groups （P 〈 0.05）. Testicular contribution was estimated to be approximately one-third of the seminal laminin. Seminal plasma laminin demonstrated significant correlation with sperm concentration （r = 0.460, P 〈 0.001） and nonsignificant correlation with age （r = 0.021, P = 0.940）, sperm motility percentage （r = 0.142, P = 0.615） and semen volume （r = 0.035, P = 0.087）. Conelusion： Seminal plasma laminin is derived mostly from prostatic and testicular portions and minimally from the seminal vesicle and vas deferens. Estimating seminal laminin alone is not conclusive in diagnosing different cases of male infertility.

Value of Pre- and Post-Treatment Platelet Indices in Patients with Immune Thrombocytopenic Purpura

Introduction: Immune thrombocytopenic purpura (ITP) is an acquired disorder characterized by isolated thrombocytopenia. There is no “gold standard” test that can establish the diagnosis of primary ITP. Therefore, the diagnosis is one of exclusion and is based on patient history, physical examination, complete blood count, and blood smear review. Platelet indices are biomarkers of platelet activation, allowing extensive investigations focusing on the diagnostic and prognostic values in various diseases without extra-costs. Mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) were investigated aiming at evaluating the correlation between pre- and post-treatment values in ITP patients. The sensitivity and specificity of platelet indices for assessment of their predictive value for treatment response were also evaluated. Methods: Fifty newly diagnosed primary ITP patients were selected from the Hematology Clinics of Ain Shams University Hospitals and classified into pediatric and adult groups. Platelet count, MPV, PDW, PCT have been recorded for all pre and post-treatment CBC samples using Beckman Coulter LH750 analyzer. Results: In pediatrics post-treatment MPV and PDW were significantly decreased while PCT was increased when compared to their values at the time of presentation (P < 0.01). The same results were obtained in adult patients, except for PDW which did not attain any significance. A significant correlation was found between pre-treatment values of these platelet indices and treatment response in pediatrics, while no significance was found between pre-treatment PDW and treatment response in adults. Conclusion: Increased pre-treatment MPV and PDW, and decreased PCT can provide diagnostic and predictive value for treatment response in ITP patients.

Diagnostic and Prognostic Value of Nuclear Factor Kappa-B in Diffuse Large B Cell Lymphoma in Egyptian Patients with Hepatitis C Virus Genotype 4

Background: Members of the NFκB [p65] family have potential diagnostic and prognostic role in various inflammatory diseases and Lymphomas. Aim: We studied NFκB [p65] in paraffin blocks of hepatitis-C-virus [HCV] positive genotype-4 and HCV negative diffuse large B-cell lymphoma [DLBCL] patients, aiming at identification of its differential expression and prognosis in DLBCL and its subtypes;GCB and ABC. This is to establish its relation to HCV infection and its role in lymphogenesis. Besides assessing the role of new directly acting antiviral drugs [Sofusbuvir/Ledipasvir] concomitantly administered to [CHOP] combination in HCV positive DLBCL. Subjects and Methods: NFκB [p65] expression was assessed using Anti-NFκB [p65] antibody semi-quantitative technique in 30 newly diagnosed DLBCL patients [HCV positive [n = 15], HCV negative [n = 15]. Results: NFκB [p65] expression was higher in the HCV positive DLBCL patients than their HCV negative counterpart, with a positive correlation with the viral load [r = 0.536, p = 0.088]. NFκB [p65] expression was significantly more frequently detected in the ABC subtype than GCB subtype [p = 0.04]. Patients who expressed NFκB [p65] had higher incidence of extranodal involvement, advanced stages, higher LDH levels and IPI score. Besides, the expression of NFκB [P65] revealed an inferior overall response [OR] [p = 0.044]. Higher complete response rates to CHOP concomitantly with antiviral [ledipasvir/sofosbuvir] were encountered in the HCV positive group. In HCV positive group, NFκB [P65] displayed a positive relationship with the viral load and liver enzymes [p = 0.04], besides an inverse relation with serum albumin. This raises the possibility that NFκB [p65] expression is suggestive of the hepatic necro-inflammation in HCV patients. The ABC group presented more in advanced stages than GCB. Higher frequency of the ABC subgroup exhibited intermediate to high viral load, while it was less in the GCB. A statistically significant difference was found in the NFκB [p65] positive patients as regards MUM1 expression among the two groups [p ≤ 0.001]. Double positive [CD10+, MUM1+] and triple negative [CD10-, BCL6-, MUM1-] cases were encountered in the HCV positive group, and were characterized with a high NFκB [p65] expression. Conclusion: NFκB [p65] is expressed in patients with DLBCL, more frequently in ABC than in GCB subtypes. Expression of NFκB [p65] is associated with poor response to therapy in DLBCL. The NFκB [p65] disclosed an increased expression in HCV positive DLBCL compared to HCV negative group. The viral load displayed a positive correlation with the NFκB [p65] expression. Simultaneous administration of DAAs in combination with CHOP disclosed a better response and high tolerability.

Study of angiotensin converting enzyme and genotype among Egyptian preeclampsia patients

Preeclampsia is a frequent disorder with reported incidence in pregnancies. In Egypt, it complicates 6%-8% of pregnancies and reaches 15% in referral centers. The renin-angiotensin system activation during the early stages of Preeclampsia proved to be a direct cause. Women carrying the D allele of the ACE-I/D polymorphism have higher measures of uterine artery resistance, which is a marker for development of intrauterine growth retardation and preeclampsia. The maternal syndrome of preeclampsia (PE) during the latter half of pregnancy is believed to result from impaired placentation in early gestation and a failure to develop low resistance uteroplacental circulation. Aim: The aim of this study was to evaluate the association with angiotensin converting enzyme gene polymorphism and changes in its enzyme serum level in preeclamptic patients compared to non preeclamptic control group together with studying the changes in umbilical artery and uterine artery Doppler. Subjects: The study was conducted on 180 pregnant women allocated into two groups having the same inclusion and exclusion criteria except for hypertension and proteinuria;each group comprised of 90 pregnant women with matched age. Methods: Doppler study of umbilical and uterine arteries and the detection of Angiotensin converting gene polymorphism by PCR with Estimation of serum ACE in serum by ELISA technique. Results: The distribution of the ACE-I/D genotypes and allelic frequencies in the present study of polymorphism was 37.8% for the DD, 48.9% for the ID, 13.3% for the II in preeclampsia group while it was 33.3% for the DD, 46.7% for the ID, and 20% for the II in the control group. There was no significant difference between cases and controls regarding the cumulative D effect. Conclusions: No existence of a relation between preeclampsia and ACE gene polymorphism considering different modes of inheritance whether is dominance or recessiveness. No effect of ACE gene polymorphism is on ACE serum level. Positive correlation between ACE gene polymorphism and the uterine artery Doppler changes gives strong evidence that ACE gene may have a role in the histopathological changes taking place in these vessels, therefore affecting maternal prognosis. It is unclear to explain this mismatched ACE genetic influence on the incidence of preeclampsia, but the multifactorial pathogenesis of the development and complication in preeclampsia and also physician’s intervention may contribute to the pregnancy outcome. Recommendations: International collaborations, particularly among countries with a high incidence of preeclampsia, may help to include participants with different cultural and genetic backgrounds, which can provide further insight into the etiology of the disease both genetic and environmental.

Prognostic Significance of Apoptosis Regulators in B-Cell Chronic Lymphocytic Leukemia

Background: High levels of MCL-1 and BCL-2 proteins have been found in Chronic Lymphocytic Leukemia (CLL), and inversely correlated with response to treatment. BCL-2/Bax ratio is the main director of apoptosis in CLL. The study aimed to clarify the prognostic role of MCL-1, BCL-2 and BCL-2/ Bax ratio in B-CLL. Patients & method: Estimation of MCL-1, BCL-2 and Bax expressions by a flow cytometry in 45 B-CLL patients and the prognostic value of these markers were correlated with other well-known established prognostic markers and treatment response. Results: MCL-1 was expressed in 60% of cases while BCL-2 was expressed in 82.2% of cases. MCL-1 expression was significantly high in male gender, short lymphocyte doubling time (LDT), and high expression of CD 38 (p β2M, CD38 expression), low ZAP-70 expression, splenomegaly and higher Rai stage were significantly increased in patients with high expression of BCL-2 (p β2M, high C-D38 expression, low ZAP-70 expression, the poor cytogenetic and splenomegaly in patients with high expression of BCL-2/ Bax ratio (p In conclusion: MCL-1, BCL-2 expressions and BCL-2/Bax ratio could be useful potential predictive and prognostic markers in B-CLL.

Relationship of Cognition, Depression and Anxiety to Glycemic Control in Older Adults with Diabetes

Objective: This study aimed to assess the relationship of cognition, depression and anxiety to glycemic control in elders with diabetes. DM is a chronic medical condition. Its control depends on adherence to medical therapy and making decisions related to lifestyle changes. This decision making capacity is affected by many factors including cognition and psychological status. Design: It was a case control study. Setting: It was done in Ain Shams University Hospital inpatients and DM outpatient clinic, Cairo, Egypt. Participants: Of the one hundred diabetic patients aged ≥ 60 years, 50 had Hemoglobin A1c (HbA1c) ≥ 7.5 (cases) and 50 had Hb A1c 7.5 (controls). Measurements: Cognition was assessed using minimental status examination (MMSE) test, Mattis Organic Mental Syndrome Screening Examination (MOMSSE) and Cambridge Cognitive Examination (CAMCOG) test. Geriatric depression scale-15 (GDS-15) was performed for depression assessment, while anxiety was assessed by DSM IV criteria. Laboratory investigations included: fasting blood sugar (FBS), post-prandial blood sugar (PPBS), glycated haemoglobin (Hb A1c), low density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, and triglycerides (TG). Results: Significant difference was found between the two groups regarding scores of cognitive tests: MMSE score (p = 0.004);below average (p = 0.02) and average scores (p = 0.05) of MOMSSE;CAMCOG score (p = 0.015);and CAMCOG divided items score including orientation (p = 0.003), comprehension (p = 0.005), expression (p = 0.020), attention (p = 0.002), and abstraction (p = 0.008) as well as depression screening scores (P = 0.002). Using Receiver Operating Characteristic, CAMCOG had better sensitivity and MOMSSE had better specificity. Conclusion: Cognitive impairment was associated with poor glycemic control, and impairment in attention and abstraction, related to executive function, functions were found to be associated with poor glycemic control. These functions may be more needed in self management of DM and hence affected glycemic control. Depression was associated with poor glycemic control but anxiety was not.

Study of Vitamin D Receptor (VDR) Gene Polymorphisms among Egyptian Cohort Patients with Different Stages of Colorectal Cancer

Colorectal cancer represents the third cancer worldwide. Studies showed thatinsufficient levels of vitamin D may result in colorectal cancer. Genetic variations in genes controlling vitamin D activity would play a role in determining susceptibility to colorectal cancer. Aim of the work: to study the different genotypes of VDR polymorphisms and detect the association between serum levels of 25(OH)VitD and 1,25(OH)2VitD among sample of Egyptian patients with different stages of colorectal cancer. Methods: Ninety patients (60 with different stages of colorectal cancer and 30 patients with benign pathology of the colon) together with 30 healthy controls were examined using PCR-RFLP analysis for FokI, ApaI and TaqI polymorphisms. Results: Genotype distribution for ApaI polymorphism showed no statistically significant difference between patients (colorectal cancer and benign) and controls with p = 0.1. There was no statistically significant difference in FokI polymorphism where p = 0.26 and genotype distribution for TaqI was also insignificant with p = 0.016. The median serum level of 25(OH)VitD was low in cancer cases compared to the control group and benign cases with (p 0.001). There was no statisticallysignificant difference of median serum level of 1,25(OH)2VitD between benign and cancer cases. There was statistically significant difference of median serum level of 25(OH)VitD and 1,25(OH)2VitD between stage I and stage II with (p = 0.004) and (p 0.001), and between stage I and stage III with (p = 0.001)and (p 0.001), but no statistically significant difference between stage II and III with (p = 0.514). Conclusions: There is ethnic variability in vitamin D receptor gene polymorphisms. The lack of significant association of the studied gene polymorphism in our population suggests that its association with other functionally known gene polymorphism might have a role in the pathogenesis of colorectal cancer.

Peripheral and Tissue Lymphocytes as Predictors of Pathological Response in Locally Advanced Rectal Cancer Post Neoadjuvant Chemoradiotherapy

Background: Tailoring therapy is the target in the management of any cancer;if factors which can predict response to treatment are identified, we can individualize treatment. Locally advanced rectal cancer studies reported that tumor microenvironment and host immune response played roles in sensitivity to chemoradiotherapy (CRT) by proving that both peripheral circulating lymphocytes and tumor infiltrating lymphocytes (TILs) strongly correlated with the response rate to CRT and it impacted disease outcome. Aim of the work: We aimed to assess the predictive value of peripheral blood lymphocytes and tumor infiltrating lymphocytes by correlation with regression rate post chemo-radiotherapy in patients with rectal cancer, and to find correlation between peripheral and tissue lymphocytes. Method: Before neoadjuvant, CRT venous blood samples were obtained from 40 patients with rectal cancer, and prior to surgery. Blood cell counts in the samples were analyzed using an automated hematology analyzer and flowcytometry used to analyze lymphocyte subsets. Colonscopic biopsies were obtained before the CRT;the numbers and distributions of T cells (CD4 & CD8) were evaluated by immunostaining. Results: Pre CRT peripheral total lymphocytes, T lymphocytes, T helper, T cytotoxic lymphocytes significantly correlated with tumor regression rate (p = 0.04, 0.05, 0.06, 0.04 respectively). The density of tissue CD4(+) and CD8(+) T cells was highly correlated with tumor regression post CRT (p = 0.01 for both). The high expressions of tissue CD4 & CD 8 were significantly correlated with high number of pretreatment peripheral total lymphocytes, T lymphocytes, T helper, and T cytotoxic lymphocytes with significant p value for all. Conclusion: We concluded that peripheral lymphocytic count and its subsets have significant correlation to tissue CD4, CD8 and both can predict pathological response to CRT;enhancement of lymphocytes mediated immune response can help for outcome improvement.

Comparison between FIB-4 Index and Fibroscan as Marker of Fibrosis in Chronic HCV Infection in Egyptian Patients

The FIB-4 index is a simple and noninvasive algorithm consisting to evaluate liver fibrosis in chronic HCV infection. Aim: To evaluate the utility of FIB-4 index as a noninvasive marker to assess liver fibrosis in chronic HCV infection in comparison to transient elastography. Patients and Methods: We studied 30 patients having chronic HCV infection based on clinical features, laboratory tests, diagnostics images, Fibroscan and FIB-4 score. According to the results of Fibroscan, the 30 patients were classified into two groups in order to obtain a cutoff value to exclude patient with significant fibrosis: group Ia: 7 patients with no or mild liver fibrosis (F0-F1) and group Ib: 23 pa-tients with significant fibrosis or cirrhosis (F2-F3-F4). Group IIa: 17 patients with no or significant fibrosis (F0-F1-F2-F3) and group IIb (F4): 13 patients with cirrhosis (F4). Results: The mean of FIB-4 index increased with the increase of the fibrosis score. FIB-4 index proved to be sensitive and specific in differentiation between patients with no or mild fibrosis (F0-F1) and patients with significant fibrosis or cirrhosis (F2-F3-F4) with the best cutoff value at 1.61. It also proved to be sensitive and specific in differentiation between patients with no or significant fibrosis (F0-F1-F2-F3) and patients with cirrhosis (F4) with cutoff value at 1.88. Conclusion: The FIB-4 index enabled the correct identification of extreme types of fibrosis. Using these cutoffs (1.61 - 1.88), 87% of patients fell outside these ranges and could thus avoid liverbiopsy with an overall accuracy of 70%.