Assessment of Collagen III as a Non-Invasive Biomarker in HCV Induced Liver Fibrotic Patients

Introduction/Objective

Liver biopsy is still the gold typical for assessing hepatic fibrosis. Non-invasive serum parameters measurement leads to essential changes in diagnosis. This procedure is painful, carries a risk of bleeding and infection, and is accompanied by a high sampling error rate. New biomarkers that can accurately predict the stage of fibrosis are urgently needed.

Objectives

This study aimed to identify, characterize, and detect serum collagen III in patients with HCV-induced liver fibrosis and healthy subjects.

Methods/Case Report

The study subjects were divided into two groups; group1: included 118 patients with HCV-induced liver fibrosis (60 males and 58 females). Group2: included 50 healthy comparable control subjects (27 males and 23 females). Collagen III was identified in serum samples of group1 at 70 kDa using collagen III polyclonal antibody and western blot analysis techniques. Additionally, it was purified from serum samples using the electroelution technique from preparative slab gels. The purified antigen gives a single sharp band at 70 kDa when resolved by SDS–PAGE (sodium dodecyl sulfate-polyacrylamide gel electrophoresis) and stained with coomassie blue. The 70 kDa purified collagen III showed high reactivity towards the collagen III polyclonal antibody. We used the ELISA method to quantify the collagen III, dose-response curve for purified collagen III as a function of the concentration in serum samples of liver fibrosis patients was done.

Results (if a Case Study enter NA)

The collagen III was identified in 62% of patients, and 38 % were negative collagen III (false negative) in group one. For group two, 96% of total healthy volunteers were negative for collagen III, and 4% were positive for collagen III (false positive). The mean ± SD of serum collagen III concentration was (8.38±3.56) and (3.2±0.59) for groups 1 and 2, respectively, with (P<0.0001).

Conclusion

The non-invasive assessment of liver fibrosis by collagen III has shown promising diagnostic and prognostic potential.

The Association Between Serum Hyaluronic Acid Levels and Routine Liver Function Tests in Liver Fibrotic HCV Patients

Introduction/Objective

Liver fibrosis is the excessive accumulation of extracellular matrix proteins, including collagen, that occurs in most types of chronic liver diseases. Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and often requires liver transplantation. Markers (NIM) of Liver Fibrosis, such as hyaluronic acid, help evaluate the stage of fibrosis in patients with liver fibrosis. This study aims to investigate whether or not there is a correlation between serum hyaluronic acid levels and liver function tests in patients who suffer from chronic HCV-induced liver fibrosis.

Methods/Case Report

This study was conducted on 118 (60 males and 58 females) patients recruited from Internal Medicine Dept., Mansoura University Hospitals, Egypt. The patients were diagnosed with chronic HCV-induced liver fibrosis. Also, we included 50 healthy comparable control subjects (27 males and 23 females). Routine laboratory tests such as AST, ALT, albumin, total bilirubin, and platelets count were performed. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. The AST-ALT ratio was calculated as [AST/ ALT]. According to the manufacturer's instructions, the serum levels of hyaluronic acid were measured by radioimmunoassay.

Results (if a Case Study enter NA)

We observed a statistically significant positive correlation was found between serum hyaluronic acid levels and APRI (r=0.3, p=0.001), ALT (r=0.3, p=0.003), AST (r=0.3 and p=0.01), and total bilirubin (r=0.3 and p=0.002). Furthermore, there was a statistically significant negative correlation between serum hyaluronic acid levels and albumin (r= -0.43, p=0.0001), and platelets count (r= -0.4, p=0.0001).

Conclusion

The levels of hyaluronic acid in the body and the results of other liver function tests tend to rise in tandem, which suggests a significant relationship between the two. This may assist us in constructing an accurate picture of the patient's condition, which will lead to a more precise diagnosis.

In Vitro Activity of Clinically Used Farnesol and Other Antifungals Against Pre-formedCandida albicans Biofilms

Introduction/Objective

Introduction: The emergence of antifungal resistance patients after long-term antifungal treatment shows an urgent need to develop new antifungal therapies. The ability of Candida albicans cells to form biofilm is resistant to many antifungal agents; it causes about 90% of vaginal yeast infections. Farnesol has a critical regulatory (quorum-sensing) molecule in C. albicans biofilm formation, a phenomenon that may be relevant to C. albicans biofilm formation. This study aims to prophesy the effect of Farnesol against pre-formed Candida albicans biofilms on the Intra-uterine devices (IUDs) users in Egypt.

Methods/Case Report

The study was carried out in The Delta region, Egypt, and included 325 females using IUDs with vaginitis syndromes with a median age of 20 to 45 years. About 291 (58.75%) Candida albicans were isolated from all cases. Vaginal swabs and IUDs were collected. The cultural characters identified the isolated organisms; the formation of biofilm in vitro was identified by (polystyrene multiwell microtitre plates (96 flat bottoms wells & Polymetheylmethacrylate strips (PMMA)). Antifungal susceptibility testing of plaktonic cells was identified by (The broth microdilution method, Spectrophotometric Modified Microdilution Method, and Colorimetric Modified Microdilution Method). In vitro activity of clinically used fluconazole, amphotericin B, and farnesol against pre-formed biofilms formed using RPMI was assessed using the XTT-reduction assay.

Results (if a Case Study enter NA)

Values of Candida biofilm untreated with antifungals were 11 independent biofilms formed in each of 8 different rows of the same 96 wells microtiter plate. The experiments showed the increased resistance of sessile C. albicans cells to fluconazole and amphotericin B. Farnesol was the only antifungal agent which showed potent activity indicated by the low SMIC80 values (0.03125μg/ml).

Conclusion

This study highlights the drastic reduction of Franesol on C.albicans biofilm. We recommend using Franesol as an antifungal agent for C.albicans in Egypt.

The Correlation Between Serum Collagen III Levels and APRI in Liver Fibrotic HCV Patients

Introduction/Objective

Noninvasive Markers (NIM) of Liver Fibrosis help evaluate the stage of fibrosis in patients with no clear indication for a liver biopsy, such as patients with chronic hepatitis C who need monitoring of the stage of fibrosis during or after treatment. The perfect NIM for hepatic fibrosis should be inexpensive, safe, simple, reliable, and well-validated in different forms of chronic liver disease.

Aim of the work

Find if there is a correlation between serum collagen III and APRI as noninvasive markers in patients with HCV-induced liver fibrosis.

Methods/Case Report

118 patients with HCV induced liver fibrosis (60 males and 58 females) and 50 healthy comparable control subjects (27 males and 23 females) were enrolled in the study. Collagen III was identified in serum samples of HCV-induced liver fibrosis patients at 70 kDa using collagen III polyclonal antibody and western blot analysis techniques. Collagen III was purified using the electroelution technique and then quantified using the ELISA technique. AST, ALT, albumin, and total bilirubin were measured. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. The AST-ALT ratio was calculated as [AST/ ALT].

Results (if a Case Study enter NA)

There was a statistically significant difference between the diseased and control groups (P<0.0001) regarding collagen III and APRI. Also, significant positive correlation between serum collagen III, APRI, and ALT levels (r=0.3 and p=0.02). However, there were no correlations between serum collagen III levels and AST, Albumin, Total Bilirubin, and AST/ALT ratio (r=0.15, -0.26, 0.22, and -0.027), respectively.

Conclusion

Collagen III and APRI is a promising diagnostic and prognostic potential in the noninvasive assessment of liver fibrosis as their levels elevate with each other. So, we can powerfully depend on them in liver fibrosis diagnosis in chronic HCV patients.

Crisis of Vaginitis;Candida albicans in Intrauterine Device (IUD)

Introduction/Objective

Fungal infection is usually caused by an overgrowth of yeast typically found in the vaginal flora. The major pathogen C. albicans is the best-characterized member of the Candida clade. Candida species are common inhabitants of the female genital tract, and the use of intrauterine devices (IUDs) has been associated with pelvic inflammatory diseases. This study explored the relationship between insertion (IUDs) and candidiasis.

Methods/Case Report

350 female patients using IUDs suffering from vaginitis from The Delta region, Egypt, were enrolled in this study. The median age was 20 to 43 years old. Vaginal swabs and IUDs were collected. Patients were classified according to the period of using IUDs as the following. Group 1: 46 users of IUDs for a period of one month to one year. Group 2: 85 users for one year to 5 years. Group 3: 171 users for five years to 10 years. Group 4: 52 users for 10 years to 20 years. The cultural characters identified the isolated organisms (morphological characters of the purified fungal isolates were carried out according to the organism's colony characters and biochemical tests).

Results (if a Case Study enter NA)

: 292 patients were positive for Candida albicans. We observed that 38 (5.59 %), 41 (11.2 %), 163 (7.6 %), and 48 (5.93 %) cases have positive Candida albicans for group1, group2, group2, and group4 respectively. There was a statistically significant difference between the occurrence of Candidiasis and IUDs in all studied groups P-value was ≤ 0.05.

Conclusion

In Egypt, women who use intrauterine devices have a higher chance of developing vaginitis. The findings indicated that women who used IUDs for longer periods of time had a higher risk of developing candidiasis. We advocate for the regulation of IUDs and the education of women on how to recognize the symptoms of candidiasis vaginosis and how to properly treat it.

Commonly Isolated Organisms Isolated from Urine Cultures In United Arab Emirates (UAE)

Introduction/Objective

Urinary tract infection is the most common reason for infection in the hospital setting, nursing home residents, and the second most common infection in the overall population. Females are more at risk of getting urinary tract infections (UTIs) than males. UTIs remain very common as 50% of women report having at least one UTI in their lifetimes. The risk is higher for older patients, especially when they have a catheter.

Objectives

The current study aimed to determine the commonly isolated organisms from urine cultures In United Arab Emirates (UAE).

Methods/Case Report

The study was performed on 4885 urine cultures collected from patients in the United Arab Emirates. The system has identified the micro-organisms using a fluorogenic methodology for organism identification and a turbidimetric method for susceptibility testing using a 64-well card that is barcoded with information on card type, expiration date, lot number, and unique card identification number.

Results (if a Case Study enter NA)

A total of 4885 urine cultures were collected; 3793 (77.6%) urine samples were collected from females and 1092 (22.4%) from males. We identified 81 organisms that have been isolated from all urine cultures. The most frequently isolated organisms were eight organisms 4017 times out of the 4885 (82.2%), whereas the other 73 organisms were found in 868 cultures representing only (17.8%) of the whole samples. E. coli was the most isolated organism by 2078 times, representing (42%) of total isolated organisms. The number of samples in the other seven common isolated organisms was 762 for Klebsiella pneumonia, 330 for group B streptococci, 307 for Enterococcus faecalis, 218 for Candida albicans, 197 for Pseudomonas aeruginosa, 84 for Staphylococci aureus, and 41 for Staphylococci saprophyticus representing (16%), (7%), (6%), (4.5%), (4%), (1.7%), (1%) respectively of the total number.

Conclusion

The study revealed that E. coli was the most common cause of urinary tract infection, followed by Klebsiella pnumonaie. Women with recurrent UTIs are worth concern for antimicrobial prophylaxis. This study gave us a clear picture of the main causative agents of UTIs so that it might help select medication.

First Massive Transfusion Protocol (MTP) Implementation Proposal in Egypt

Introduction/Objective

Massive transfusion is often defined as transfusion of adults with 10 or more of packed red blood cells units in 24 hours period or transfusion of 4 or more units of packed red blood cells (PRBCs) in one hour when on-going need for more transfusion is foreseeable. Massive transfusion protocol in children is defined as transfusion of >40 mL/kg. Massive transfusion protocol (MTP) is a vital element of damage control resuscitation and provides a coordinated clinical response to hemorrhage in patients requiring massive blood transfusions after hospital admission. Hemorrhage is the most common cause of death within the first hour of arrival to the trauma center.

Methods/Case Report

This study aims to develop and establish the first massive protocol in Egypt to provide a consistent treatment for blood transfusion for trauma patients that will Reduce delay in ordering and administering blood products and Deliver a reasonable ratio of plasma to red blood cells. The protocol will be first implemented in a military hospital in Egypt. Developing the massive transfusion protocol will allow the practitioners to follow algorithm for rapid replacement of blood products using uncrossmatched packed red blood cells, Plasma, platelets and cryoprecipitate if necessary. Adopting the American Association of Blood Banks (AABB) and the American College of Surgeons (ACS) guidelines are the best practice around the world. The Protocol will be developed by multidisciplinary committee engagement, Blood bank, Diagnostic laboratory and Clinical care areas (OR, ER, ICU, OBS).

Results (if a Case Study enter NA)

The massive transfusion protocol ratio will be 3:2 (RBC: FFP) and one units of platelets for every 6 units of RBC. according to American College of Surgeons (ACS) guidelines the ratio should be 1:1 to 1:2 (RBC: FFP). The committee established defined criteria for MTP activation and termination. The delivery time of the blood products should be between 5-10 minutes. Administration of tranexamic acid to inhibit plasminogen activation and stabilize the clot.

Conclusion

The Developing and Implementing MTP in Egypt will provide reduction in mortality for trauma and uncontrolled hemorrhage patients. Once implemented, we will regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes., the MTP will be evaluated to ensure best practice.

The role of Aspartate Aminotransferase-to-Platelet ratio (APRI) in the Prediction of Liver Fibrosis in Chronic HCV Patients

Introduction/Objective

Chronic hepatitis C virus (HCV) infection is typically characterized by slowly progressive hepatic fibrosis, with progression from stage 0 (no fibrosis) to stage 4 (cirrhosis). Aspartate aminotransferase-to- platelet ratio (APRI) may be a simple and convenient noninvasive diagnostic test because it is based on the regular laboratory tests and demographic data. However, its overall test performance in various settings remains questionable.

Methods/Case Report

Objectives: This study aimed to evaluate the diagnostic accuracy of APRI in the prediction of hepatic fibrosis. Subjects and Methods: Serum samples were collected from patients recruited from Internal Medicine Dept., Mansoura University Hospitals, Egypt. The study included 118 liver fibrosis patients associated with chronic HCV infection (60 males and 58 females) and 50 age-matched healthy volunteers (27 males and 23 females). The HCV infection was diagnosed based on biochemical, serologic, and histological criteria. All samples of fibrotic liver patients showed a positive result for anti-HCV Abs using ELISA as a confirmatory test. AST, ALT, albumin, and total bilirubin were measured using standard methodologies. Routine blood pictures, including platelets counting were determined. The AST-ALT ratio was calculated as [AST/ ALT]. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100.

Results (if a Case Study enter NA)

There was no statistically significant difference between sex distribution in liver fibrosis patients and healthy volunteers. The mean±SD was (46.1±10.44 and 33.3±11.13) respectively. The medians of the selected laboratory markers in the healthy group and liver fibrotic patients were (41,39), (272.5,167), (36,54), (35.5,51), (0.9,0.98), (0.71,2.5), and (0.34, 0.86) for Albumin, Platelet count, AST, ALT, AST/ALT ratio, Total Bilirubin, APRI respectively. There was a statistically significant difference between the two groups in all laboratory parameters (p<0.001) and for APRI (p<0.0001).

Conclusion

The evaluation of APRI is uncomplicated, inexpensive, and has a reasonable degree of diagnostic accuracy in determining whether or not patients with chronic HCV have liver fibrosis.

Biofilm Formation on Intrauterine Devices in Diabetic and Nondiabetic Patients with Vulvovaginal Candidiasis

Introduction/Objective

Women with diabetes mellitus (DM) are more susceptible to vulvovaginal candidiasis (VVC) than non-diabetics. This could be due to higher glucose levels predisposing VVC by damaging basic host defense mechanisms and stimulating Candida adhesion to vaginal cells.

Objectives

Investigating the prevalence of Candida albicans and biofilm formation in diabetic and nondiabetic IUD users.

Methods/Case Report

A total of 325 vaginal swabs and IUDs were enrolled in this study from the Delta region in Egypt. Females with a median age of 17 to 45 years were divided into two groups; diabetic (29.8%) and nondiabetic (70.1%). They were all vaginitis having one of these symptoms; irritation on the surface of the genital tract, uterine cervix ulcer, vaginal bleeding, and acute vaginal exudates. C. albicans were isolated and identified using cultural characters. Biofilm formation by Candida on removed IUDs and swabs was examined by XTT-reduction assay, scanning electron microscope (SEM), and transmission electron microscope (TEM). Antifungal susceptibility to fluconazole and amphotericin B (AMB) to isolated strains and in vitro experimental biofilm formation was performed.

Results (if a Case Study enter NA)

In diabetic cases, the highest percentage (91.1%) of isolated C.albicans was found among patients with irritation on the surface of the genital tract, whereas the lowest one (83.3%) was in the symptoms of acute vaginal exudates. In nondiabetic cases, the highest percentage of isolated C.albicans (51.7%) was found among patients with symptoms of acute vaginal exudates. In contrast, the lowest one (32.5%) was in the symptoms of irritation on the surface of the genital tract. XTT method illustrated the biofilm formation; SEM revealed a heterogeneous thick biofilm. Biofilm MIC to strains with AMB >1μg\ml was considered resistant, while those for which AMB concentration were ≤1μg\ml were deemed sensitive. Strains with Fluconazol 64 μg\ml were considered resistant, while those for which Fluconazol concentration was ≤8 μg\ml were deemed sensitive.

Conclusion

There was a significant direct relationship between diabetic cases and C.albicans prevalence in the current study. Furthermore, the ability to form biofilm was found to be the same in diabetic and nondiabetic patients.

The Correlation between Serum Creatinine and PTH Levels in Dialysis Patients in Egypt

Introduction/Objective

Chronic kidney disease (CKD) is affecting about 14% of the general population. CKD is associated with a decrease in calcium level in the body. In the early stages of (CKD), dialysis may not be needed. The late stages of CKD will require dialysis or a kidney transplant to save a life.

Secondary hyperparathyroidism is a crucial disorder in CKD patients. It explains why the illness causes a significant change in bone and mineral metabolism. This study aims to study renal hyperparathyroidism (rHPT) in dialysis patients with late-stage of chronic kidney disease (CKD).

Methods/Case Report

A total of 55 subjects were enrolled in this study for late-stage dialysis patients from Egypt. Serum creatinine and PTH levels were measured. Among the 55 subjects; 41 subjects (74.5%) were males, 14 subjects (25.5%) were females with a mean age of 52.7 and 34.3 years for males and females, respectively.

Subjects were divided into two groups; Study group I consists of 33 dialysis patients; three patients were females (9%) while 30 patients were males (91%), and control group II consists of 22 healthy individuals, 11 subjects were females (50%), and 11 subjects were males (50%).

Results (if a Case Study enter NA)

In our study, in comparison between two groups as regards blood investigations. The means of creatinine and PTH in the study group I were 8.93 mg/dl and 316.8, while in the control group II were 0.9, and 38.4 respectively.

Comparing the two groups shows that mean of Creatinine and PTH in the study group was statistically significantly higher than the control group (p-value less than 0.001).

Conclusion

In patients with CKD, accurate measurement of (PTH) is critical for treatment decision-making to reduce the risk of bone and cardiovascular diseases.

We recommend that patients with diabetes and high blood pressure be aware that they must take their medications consistently to avoid kidney problems.

Vitamin D deficiency Crisis in Egypt

Introduction/Objective

Vitamin D deficiency is a worldwide health problem. Even with the latest medical technology worldwide, vitamin D deficiency is still an ignored epidemic. More than a billion people globally are vitamin D deficient or insufficient. Vitamin D is essential for strong bones as it is responsible for the absorption of calcium, magnesium, and phosphate in the human body. It is essential for building the human immune system and legalizing cell growth. Vitamin D deficiency can result in muscle vulnerability, pain, tiredness, and depression. Severe Vitamin D deficiency can cause Rickets disease.

Objectives

This study aims to predict the percentage of vitamin D deficiency in Egypt.

Methods/Case Report

A total of 498 subjects were enrolled in this study from the Cairo region in Egypt; 203 (41%) were male, 260 (52%) were female, and 35 (7%) were children with a median age of 36.2 years, 36.7 years and 5.3 years respectively. A fully automated chemiluminescence immunoassay analyzer (CLIA) was used to measure Vitamin D in all subjects’ specimens.

Results (if a Case Study enter NA)

The overall prevalence of Vitamin D deficiency was 90.09%. Among the 498 patients, 453 patients (90.09%) were Vitamin D deficient (less than 30 ng/ml), while 45 patients (9.03%) of the patients were within the normal Vitamin D range. It was observed that 192 patients (94.54%) of males,237 patients (91.15%) of females, and 11patients (31.42%) of children were Vitamin D deficient. Furthermore, 11 patients (5.41%) of males, 23 patients (8.84%) of females, and 23 patients 65.71% of children are within the normal Vitamin D range.

Conclusion

Our findings reveal a significant frequency of vitamin D deficiency in Egypt. Inadequate sun exposure, Insufficient dietary calcium, gastrointestinal disorders, renal diseases, and liver diseases contribute to vitamin D deficiency. We recommend that the Egyptian Health ministry launch an awareness campaign for the severe Vitamin D deficiency in Egypt.