Background Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common cause of chronic liver disease worldwide. Multiple diagnostic noninvasive methods for NAFLD were studied (both serological and imaging), either single or combined. Attention has been focused on cytokeratin-18 (CK18) as a novel serological marker for the diagnosis of steatosis/fibrosis in NAFLD and hepatitis C virus (HCV) patients. Aim The aim of this study was to evaluate serum CK18 in NAFLD and HCV fibrosis/steatosis and also to correlate its performance with the diagnostic accuracy of transient elastography (TE) and controlled attenuation parameter (CAP) in the diagnosis of fibrosis/steatosis in these patients. Patients and methods Three equal groups of participants were enrolled (n=135): group I included patients with chronic HCV, group II included NAFLD patients, and group III included control participants. For all groups, TE/CAP and labs including serum CK18 were performed. Liver biopsy was performed for the NAFLD group. Results Serum CK18 was significantly higher in the NAFLD group (19.01±3.49 ng/ml) versus the HCV group (8.95±1.06 ng/ml) and the control group (4.83±1.6 ng/ml) (P<0.001). The CK18 levels in biopsy stages (steatosis, ballooning, inflammation, and fibrosis) and FibroScan/CAP degrees showed that CK18 increased significantly with steatosis and fibrosis stages (biopsy or FibroScan/CAP), but did not reach significance with ballooning or inflammation grades. CK18 was significantly different in nonalcoholic steatohepatitis versus non-nonalcoholic steatohepatitis patients (P=0.041). The best CK18 cutoff to detect steatosis (S≥2) in NAFLD and HCV was 11.65 and 6.84 ng/ml, respectively with an overall sensitivity and specificity over 97%. The CK18 cutoff for significant fibrosis (F≥2) by FibroScan in the NAFLD/HCV groups was 9.115 ng/ml, with 62.5%/69.2% sensitivity/specificity (P=0.031). However, inflammation had a cutoff with a marginal P value (P=0.080), and a reliable cutoff for ballooning was not attained (P=0.386). There was a positive correlation between CK18 and fibrosis (by FibroScan) in the NAFLD and HCV groups (P<0.05). The correlation between CK18 and steatosis in CAP and the nonalcoholic fatty liver disease activity score was very good (P<0.001). Conclusion Serum CK18 is related strongly to the development/progression of NAFLD and HCV-related fibrosis/steatosis. TE was correlated highly with liver biopsy results. The combination of CK18 with other noninvasive modalities increases the diagnostic yield of these tests.
Background: Group A streptococci (GAS) is a major cause of morbidity and mortality. Erythromycin is an effective macrolide antibiotic for treating GAS infections. However, GAS macrolide resistance has been increased due to either an efflux mechanism (M phenotype), encoded by mef A gene, or by methylation of the ribosomal target resulting in resistance to macrolide, lincosamide, and streptogramin B (MLS) antibiotics. Methylase can be expressed either constitutively (cMLS phenotype) or inducibly (iMLS phenotype). Objectives: The present study aimed to find out frequency of S. pyogenes isolated from patients with upper respiratory tract infections at Beni-Suef University Hospital, determine rate and mechanism of macrolide resistance. Methodology: The present study was conducted on patients with upper respiratory tract infections attended to otorhinolaryngology clinic, Beni-Suef University Hospital, Egypt, in the period from February to December 2015. Detailed history taking was carried and clinical findings were obtained. Throat or ear swabs were taken and processed by conventional bacteriological methods. S. pyogenes isolates were further tested to determine erythromycin resistance phenotype by D- test, MIC of Erythromycin by tube broth dilution method and for mef A gene by PCR. Results: Forty two S. pyogenes isolates were identified from (100) swabs taken from either ear or throat specimens (42%), isolates resistance to erythromycin and clindamycin was 83.3% (35) and 31% (13) respectively. The pattern of macrolide resistance was 31% (13/ 42) cMLS phenotype, 52.3% (22/42) M phenotype and no isolate was iMLSB phenotype. Most strains with M phenotype expressed low-level macrolide resistance (MIC 1-4μg/ml), while cMLSB isolates showed a high level of erythromycin resistance (MIC ≥64 μg/ml) (highly significant: p-value 0.0001). The results confirmed a strong correlation between the M phenotype and the mef A gene in GAS (highly significant: p-value =0.001). Conclusion: Incidence of erythromycin resistance was evident among the isolates. To preserve the necessary efficacy, limited use of erythromycin is recommended.
Background: Implant therapy is now considered an acceptable successful way to replace hopeless teeth. the purpose of this study was to Evaluate the use of gingival mesenchymal stem cell (GMSC) on chitosan scaffold in the treatment of peri-implant defects. Method: A total of ten mongral dogs age ranging between 1 to 2 years old weight from 20 to 25kg were used in the current study. Dogs were scheduled for first premolars extraction one on each side and immediate replacement by immediate implant at mesial socket with creation of peri-implant defect at distal socket. Sites were randomly assigned in a split mouth design into two groups: control group in which the defects were filled with chitosan only, intervention group in which the defects were filled by Gingival Mesenchymal Stem Cells (GMSCs) carried on chitosan scaffold. Five dogs will be sacrificed 1month and the others will be sacrificed at 3 months post operation. Bone density was measured around each implant at defect sides at baseline (implant insertion), 1 month and 3 months. Results IBM SPSS 28 for windows software was used for the analysis, there was a significant difference in bone density change, as bone density change was higher in intervention group, p-value > 0.05 at one month but there was no statistically significant difference observed between the two groups at three Oral medicine, Diagnosis and periodontology department Faculty of Dentistry Minia University Egypt Conclusion:using gingival mesenchymal stem cells in treatment of peri-implant defects gives better results in shorter duration, but same results can be reached with chitosan alone in longer duration and less costs. More studies with larger sample size are recommended.
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