Serum alpha-fetoprotein level is higher in hepatitis C than hepatitis B infected chronic liver disease patients

Background:

The frequency of raised serum alpha-fetoprotein may vary in relation to hepatitis B or C infection in chronic liver disease (CLD). The study evaluated the frequency of hepatitis B and C in patients with chronic liver disease and correlated the levels of serum alpha-fetoprotein with hepatitis B and C infection in the patients.

Materials and Methods:

Eighty-six patients with CLD were recruited for the study. Fifty subjects, with no CLD were used as control. Hepatitis B surface Antigen (HBsAg) and hepatitis C antibody were determined using enzyme-linked immunosorbent assay (ELISA) technique (Human diagnostics, Germany and HCV Murex 40 Anhet laboratories, USA) while liver function tests were evaluated using express plus chemistry auto analyzer. Alpha-fetoprotein was assayed using ELECSYS 1010 auto analyser.

Results:

There were 60 males and 26 females, with a mean age of 46 + 6.5 years, while the controls were 25 males and 25 females with a mean age of 41 ± 2.5 years. Thirty-six subjects (41.7%) were seropositive for HBsAg while 24 (27.9%) were seropositive for Hepatitis C Virus (HCV) antibody. The mean alpha fetoprotein level was 359 ± 9.9 ng/mL while mean control value was 1.93 ± 0.24 ng/mL. Liver function test parameters were elevated compared with control subjects (P < 0.001). The increase in serum alpha-fetoprotein was higher (P < 0.001) in HCV than HBsAg positive patients.

Conclusion:

Serum alpha-fetoprotein level was highest in HCV compared to HBsAg positive and hepatitis negative patients with CLD.     

Sub‐chronic exposure to paraoxon neither induces nor exacerbates diabetes mellitus in Wistar rat

There is an increasing belief that organophosphorus compounds (OPCs) impair glucose homeostasis and cause hyperglycemia and diabetes mellitus. The present study was undertaken to investigate the putative diabetogenic effect of sub‐lethal and sub‐chronic exposure to paraoxon (POX), an extremely hazardous OPC used in pesticides. The effect of paraoxon on streptozotocin‐induced diabetic rats was also examined. Each rat was injected with 100 nmol of POX 5 days per week for 6 weeks. Blood glucose levels and red blood cell acetylcholinesterase activity were measured weekly. Biochemical analysis and morphological studies were performed at the end of the experiment. The results revealed that POX neither induces nor exacerbates diabetes mellitus in experimental rats. Liver and kidney/body weight ratios revealed statistically insignificant differences when compared with controls. Biochemical analysis of urine samples showed a small but not significant increase in protein level in all groups. Urine bilirubin was significantly higher in the diabetes + POX group when compared with the control group. The number of blood cells in urine was significantly higher in the POX‐treated group compared with the control group. Hyperglycemia was noted in the diabetes and diabetes + POX groups, but neither in the saline control nor in POX‐treated normal rats. Electron microscopy of POX‐treated pancreas did not show any morphological changes in beta cells. These results suggest that POX does not cause diabetes mellitus at sub‐lethal sub‐chronic exposure. Copyright © 2012 John Wiley & Sons, Ltd.     

Functional characterization and novel rickettsiostatic effects of a Kunitz-type serine protease inhibitor from the tick Dermacentor variabilis

Here we report the novel bacteriostatic function of a five-domain Kunitz-type serine protease inhibitor (KPI) from the tick Dermacentor variabilis. As ticks feed, they release anticoagulants, anti-inflammatory and immunosuppressive molecules that mediate the formation of the feeding lesion on the mammalian host. A number of KPIs have been isolated and characterized from tick salivary gland extracts. Interestingly, we observe little D. variabilis KPI gene expression in the salivary gland and abundant expression in the midgut. However, our demonstration of D. variabilis KPI's anticoagulant properties indicates that D. variabilis KPI may be important for blood meal digestion in the midgut. In addition to facilitating long-term attachment and blood meal acquisition, gene expression studies of Drosophila, legumes, and ticks suggest that KPIs play some role in the response to microbial infection. Similarly, in this study, we show that challenge of D. variabilis with the spotted fever group rickettsia, Rickettsia montanensis, results in sustained D. variabilis KPI gene expression in the midgut. Furthermore, our in vitro studies show that D. variabilis KPI limits rickettsial colonization of L929 cells (mouse fibroblasts), implicating D. variabilis KPI as a bacteriostatic protein, a property that may be related to D. variabilis KPI's trypsin inhibitory capability. This work suggests that anticoagulants play some role in the midgut during feeding and that D. variabilis KPI may be involved as part of the tick's defense response to rickettsiae.     

Rickettsial infection in Dermacentor variabilis (Acari: Ixodidae) inhibits transovarial transmission of a second Rickettsia

This study examined the ability of ticks to maintain multiple species of spotted fever group rickettsiae via transovarial transmission. Using a capillary feeding method, previously established Ricketisia montana- and Rickettsia rhipicephali-infected cohorts of Dermacentor variabilis (Say) were exposed to R. rhipicephali and R. montana, respectively, in two reciprocal challenge experiments. Eggs collected from individual females, for two successive generations, of each cohort were assessed for rickettsial infection by polymerase chain reaction for each challenge experiment. Assessment of the eggs from challenged ticks identified that both B. montana- and R. rhipicephali-infected ticks were refractory to their respective challenge rickettsiae. The prechallenged infection rate for both F1 and F2 generations (100%) of the B. montana-infected cohort was resistant to transovarial transmission of the second rickettsia species, and only R. montana was detected in the eggs of FL = (50%) and F2 = (74%) challenged females. The R. rhipicephali-infected cohort maintained a lower level of infection (20%) in the population and did not transovarially transmit the challenge species, however, detectable levels of infection were lost after the first generation. Second-generation ticks, no longer infected with B. rhipicephali, became susceptible to infection with R. montana and female ticks (approximately 4%) were able to transmit R. montana to their progeny. The resistance of the ovaries to co-infection and apparent host-specific nature of infection suggests that rickettsial infection of tick ovaries may alter the molecular expression of the oocytes so as to preclude secondary infection with other rickettsiae.     

Clinicopathological pattern of malignant parotid gland tumors in Saudi Arabia

OBJECTIVE: To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies. METHODS: This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity. RESULTS: Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 (22 men and 10 women) and mean age of 51.8 (range 28-81 years). A painless lump was the most frequent clinical manifestation observed in 23 (71.8%) patients followed by facial nerve dysfunction in 14 (43.7%) patients. Parotidectomy was performed in 22 (68.7%) patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 (43.7%), and total nerve sacrifice in 9 (28.1%) patients. Four (12.5%) patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine (28.1%) patients had mucoepidermoid carcinoma, 8 (25%) adenoid cystic carcinoma, 6 (18.7%) adenocarcinoma, not otherwise specified, and 2 (6.2%) were reported to have carcinoma in pleomorphic adenoma. Twenty (62.5%) specimens revealed high-grade aggressive lesions, and out of these, 19 (59.3%) patients presented with stage III/IV disease. CONCLUSION: Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior.     

Exploring the health visiting service from the view of South Asian clients in England: a grounded theory study

The fact that health inequalities disproportionately affect the minority ethnic population is not new and projections are that the minority ethnic population will continue to increase. The importance of early intervention and the key role that health visitors can play in attempting to reduce health inequalities is well documented as is the requirement for health providers to establish culturally sensitive services. To date, much of the research has focused on the perspectives of healthcare professionals caring for minority ethnic clients in hospital‐based settings and little is known about the perspectives of minority ethnic clients regarding the health visiting service (HVS). The aim of this study was to explore the perspectives of South Asians regarding their experiences with the HVS. The study was conducted in a small town in the South of England between March and June 2013. A qualitative study using a grounded theory approach was used to capture the perspectives of this group regarding their interactions with the HVS. The sample consisted of 15 participants and data were collected through audio‐recorded semi‐structured interviews and analysed using constant comparative approach. Three key categories were identified: ‘understanding the health visitor's role’, ‘sensitivity of services’ and ‘the significance of family’. While clients valued one‐to‐one support from health visitors, there was some evidence of poor communication and ethnocentric tendencies within the service. It was found that South Asian clients distinguish between health and parenting advice, being more likely to accept health advice from their health visitor and more likely to accept parenting advice from their family. The findings, although limited in their generalisability, offer important insights into how South Asians perceive the service and will equip health visitors with a better understanding of how best to improve the experience of South Asian clients accessing the health visiting.     

Titania Nanotube Architectures Synthesized on 3D-Printed Ti-6Al-4V Implant and Assessing Vancomycin Release Protocols

The aim of this study is to synthesize Titania nanotubes (TNTs) on the 3D-printed Ti-6Al-4V surface and investigate the loading of antibacterial vancomycin drug dose of 200 ppm for local drug treatment application for 24 h. The antibacterial drug release from synthesized nanotubes evaluated via the chemical surface measurement and the linear fitting of Korsmeyer–Peppas model was also assessed. The TNTs were synthesized on the Ti-6Al-4V surface through the anodization process at different anodization time. The TNTs morphology was characterized using field emission scanning electron microscope (FESEM). The wettability and the chemical composition of the Ti-6Al-4V surface and the TNTs were assessed using the contact angle meter, Fourier transform infrared spectrophotometer (FTIR) and the X-ray photoelectron spectroscopy (XPS). The vancomycin of 200 ppm release behavior under controlled atmosphere was measured by the high-performance liquid chromatography (HPLC) and hence, the position for retention time at 2.5 min was ascertained. The FESEM analysis confirmed the formation of nanostructured TNTs with vertically oriented, closely packed, smooth and unperforated walls. The maximum cumulative vancomycin release of 34.7% (69.5 ppm) was recorded at 24 h. The wetting angle of both Ti-6Al-4V implant and the TNTs were found below 90 degrees. This confirmed their excellent wettability.     

Late-presenting complete heart block after pediatric cardiac surgery

Late presenting complete heart block after pediatric cardiac surgery is a rare complication and its management is well defined once the initial diagnosis in made timely and appropriately. In this report we described a child who underwent atrioventricular septal defect repair with a normal sinus rhythm during the postoperative period, as well as during the first 2 years of follow up.She subsequently developed complete heart block with bradycardia that required insertion of a pacemaker. Here we discuss this unusual late-presenting complication, possible risk factors, and management.