SBEM is a frequent complication in cirrhotic patients with hydrothorax. E. coli is the most frequent organism responsible for SBEM. The modified method of pleural fluid culture is more sensitive than the conventional method for diagnosis of SBEM.

BACKGROUND:Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information.OBJECTIVES:Evaluation of pleural fluid interferon (INF)-γ levels vs Quantiferon–TB Gold In tube assay (QFT- IT) in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB.METHODS:Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-γ assays. Ex vivo pleural fluid INF-γ levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy.RESULTS:The final clinical diagnosis was TB in 20 (53%), malignancy in 10 (26%), and effusion due to other causes in eight patients (21%). Ex vivo pleural fluid INF-γ levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid (70 and 78% sensitivity, with 60 and 83% specificity, respectively). QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay.CONCLUSION:The ex vivo pleural fluid INF-γ level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-γ in the diagnosis of pleural TB.

BackgroundVertical transmission of hepatitis B virus (HBV) is known to be the most common cause of perinatal infection. Purpose of the study The aim of the study was to demonstrate the prevalence and possible risk factors for HBV infection among pregnant women in upper Egypt and to target women for postpartum immunization. Patients and methods A total of 294 pregnant Egyptian women were consecutively recruited from outpatients' clinic of women healthcare center of Assiut University hospital. Clinical evaluation and questionnaire about risk factors for HBV transmission were performed. Blood samples were tested for hepatitis B surface antigen (HBsAg), antibody against hepatitis B surface (anti-HBs), and antibody against hepatitis B core (anti-HBc).Positive samples for HBsAg were tested for hepatitis B envelope antigen (HBeAg) and quantitative PCR for HBV. Newborns of HBsAg-positive mothers were tested for HBsAg immediately after labor and 9 months later. Passive-active immunization was given to newborns of HBsAg-positive mothers. ResultsThe prevalence of HBsAg among pregnant women was 4.8%. Target women for postpartum vaccination were 82.3% (those with negative anti-HBs). PCR for HBV was positive in 50% of HBsAg-positive pregnant women. None of the newborns of infected mothers were positive for HBsAg at birth and after 9 months. Previous blood transfusion, HBV infection in the family, and family history of liver disease were significant predictive factors for HBV infection in univariate analysis among Egyptian pregnant women. HBV infection in the family was the only independent predictor for HBV infection among pregnant women. ConclusionThere is an intermediate prevalence (4.8%) of HBV infection among upper Egyptian pregnant women. Family history of HBV infection is the only independent risk factor for HBV infection among pregnant women. Passive-active immunization to newborns of infected mothers resulted in 100% reduction of perinatal HBV infection.

Preoperative embolization of giant vascular thoracic tumors is useful to decrease perioperative blood loss and facilitate total excision.

Tumor necrosis factor-alfa (TNF-α) gene polymorphism is supposed to have a significant influence on the incidence of acute rejection in renal transplantation. The monocyte chemoattractant protein-1 (MCP-1) is another factor supposed to modulate graft rejection. We studied TNF-α and MCP-1 gene polymorphisms in 84 kidney allograft recipients with polymerase chain reaction and restriction fragment length polymorphism and their serum levels by enzyme-linked immunosorbent assay. The patients were classified into two groups based on their outcomes: Group I (n = 47) recipients with stable graft function as the control group and group II (n=37) recipients who experienced acute graft rejection episodes in the first 30 days post-transplantation. A significantly higher incidence of TNF 2 /TNF 2 genotype was observed among patients with acute graft rejection in comparison with the control group (40.5% and 19.2% respectively, P <0.05), while no statistically significant differences were observed in the TNF 1 /TNF 1 genotype between the groups (59.4% and 80.8%, respectively, P >0.05). A significant elevation of serum TNF-α levels was found in group II than group I and between TNF 2 genotype compared with that of TNF1 genotype within group II recipients. Distribution of MCP-1 genotypes in patients with and without acute rejection episodes was not significantly different (70.2% and 76.6% for MCP-1 A/A and 29.7% and 23.4% for MCP-1 G/G, respectively, P >0.05). The serum MCP-1 levels were not significantly different between the groups and between MCP-1 G/G genotype and MCP-1 A/A genotype in group II recipients. In conclusion, TNF-α gene polymorphism or its serum levels may identify patients at risk of acute rejection, where patients with TNF 2 /TNF 2 genotype or high serum TNF-α levels are more likely to have acute rejection episodes, while there was no relation between MCP-1 genotype or its serum levels and acute rejection.

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Backgroundand study aim: Hepatocellular carcinoma (HCC) is the most common primary liver cancer, coming 4th in most common cancers, and 2nd in cancer-related mortality in Egypt. HCC biomarkers help in case screening, diagnosis, and follow-up. This study aims at evaluating the diagnostic value of plasma osteopontin (OPN) compared to alpha-fetoprotein (AFP) for diagnosing HCC in Egyptian patients.Patients and Methods: 120 subjects in Alrajhi Liver Hospital, Assiut University were included (60 HCC, 30 liver cirrhosis, and 30 healthy individuals). Plasma OPN and AFP levels were evaluated using commercially available ELISA kits. Uncontrolled diabetic and hypertensive patients, patients with other tumors than HCC or those receiving HCC treatments were excluded.. Results: OPN plasma levels were higher in HCC group compared to cirrhotic and control groups respectively (200 vs. 77.5 vs. 25.5 ng/ml, p<0.05). Tumors >5cm in diameter resulted in significantly higher plasma OPN compared to tumors <5cm (p<0.05). Child-Pugh score, multiple tumors, or lymph nodes didn't significantly affect OPN levels in HCC group (p>0.05). Diagnostic sensitivity, specificity, and overall accuracy of OPN for HCC vs Cirrhotic group were superior to AFP (97%, 70%, and 84% at cut-off value 90 ng/mL for OPN vs 90%, 63% and 77% at cut-off value 5.5 ng/ml for AFP). The area under the ROC curve (AUC) value for OPN was higher than AUC value for AFP (0.923 vs. 0.902). Conclusion:Serum OPN had better diagnostic ability for detecting HCC compared to AFP, suggesting OPN as a promising diagnostic marker for HCC at normal AFP levels.

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