Suad Abdeen

Cysticercosis: imported and autochthonous infections in Kuwait

Intracerebral and non-central nervous system (non-CNS) cysticercosis caused by the larval pork tapeworm Taenia solium was diagnosed in patients in an Islamic state. The mode of transmission and challenges in diagnosis are highlighted. Sixteen patients with neurocysticercosis and six with non-CNS lesions were diagnosed by imaging studies (computerized tomography [CT]/magnetic resonance imaging [MRI]) and serology (ELISA and/or enzyme-linked immunoelectrotransfer blot assay [EITB]). Four of 55 family members, including servants, tested for antibodies were positive by the EITB and ELISA. Only one of these sera tested for antibodies to adult T. solium was positive: that of the cook, the probable source of the infection. We postulate a similar mode of transmission in the other Kuwaitis. Evaluation of several commercially available ELISA kits showed they were of poor specificity. Even in countries where pork consumption is proscribed by religious laws, physicians should include cysticercosis in their differential diagnosis in patients with neurological symptoms or non-CNS lesions, especially in non-endemic countries with a large expatriate population such as Kuwait. In children particularly, and in this region, suspected tuberculous lesions on CT must be investigated to rule out cysticerci by a more diligent use of the sensitive and specific EITB assay. Failure to understand the local epidemiology leads to empirical, inappropriate and prolonged therapy for chronic disease.

Effect of green tea on kidney tubules of diabetic rats

It has been documented that green tea (GT) and its catechin components improve renal failure and inhibit the growth of mesangial cells. In the present study we examined the long-term effect of GT extract on streptozotocin (STZ)-induced diabetic nephropathy and on the glycogen accumulation in the kidney tubules. Male Sprague-Dawley rats were randomly assigned to normal control groups (2, 6, 8 and 12 weeks) and five diabetic groups (n 10) of comparable age. A GT diabetic group received 16 % concentration of GT for 12 weeks post-diabetes induction as their sole source of drinking water. GT treatment significantly (P < 0.01) reduced the serum glucose, glycosylated protein, serum creatinine and blood urea N levels by 29.6 (sem 3.7), 22.7 (sem 5.2), 38.9 (sem 10) and 41.7 (sem 1.9) %, respectively, compared with the diabetic group of comparable age. In addition, the GT-treated group showed a significant 44 (sem 10.8) % higher creatinine clearance (Ccr) compared with the untreated diabetic group. Likewise, GT reduced the urea N, creatinine, glucose and protein excretion rates by 30 (sem 7.6), 35.4 (sem 5.3), 34.0 (sem 5.3) and 46.0 (sem 13.0) % compared with the 12 weeks diabetic group. Administration of GT to 12 weeks diabetic rats significantly (P < 0.001) prevented (99.98 (sem 0.27) % less) the accumulation of glycogen in the kidney tubules. These results indicate that in STZ diabetes, kidney function appears to be improved with GT consumption which also prevents glycogen accumulation in the renal tubules, probably by lowering blood levels of glucose. Therefore, GT could be beneficial additional therapy in the management of diabetic nephropathy.

Effect of green tea in the prevention and reversal of fasting-induced intestinal mucosal damage

OBJECTIVE Epidemiologic studies have suggested that high consumption of green tea protects against the development of chronic active gastritis and decreases the risk of stomach cancer. The effect of green tea on the intestinal mucosa was not studied previously, so we examined the effects of green tea on the intestinal mucosa of fasting rats in a controlled experimental setting. METHODS Two sets of experiments were performed. In the recovery set, rats were fasted for 3 d, after which they were allowed free access to water, black tea, green tea, or vitamin E for 7 d. On day 8, the animals were killed, and small bowels were removed for histologic examination. In the pretreatment set, rats were allowed a normal diet, but the water supply was replaced with green tea, black tea, or vitamin E for 14 d. They were subsequently fasted for 3 d. On day 4, the rats were killed, and small bowels were removed for histologic examination. RESULTS In the recovery set, fasting for 3 d caused shortening of villi, atrophy, and fragmentation of mucosal villous architecture, with a significant (P < 0.0001) reduction in the length and surface area of the villi. Ingestion of green tea and, to a lesser extent, vitamin E for 7 d helped in the recovery of villi to normal. In the pretreatment set, drinking green tea, black tea, or vitamin E for 14 d before fasting protected intestinal mucosa from damage. CONCLUSION The mucosal and villous atrophy induced by fasting was reverted to normal by the ingestion of green tea and, to a lesser extent, vitamin E. Black tea ingestion had no effect. In addition, ingestion of black tea, green tea, and vitamin E before fasting protected the intestinal mucosa against atrophy.

Pathobiological features of breast tumours in the State of Kuwait: a comprehensive analysis

Background Breast cancer accounts for 30.3% of all cancer types in Kuwaiti women. Death occurs in approximately 43% of these patients. Our goal was to conduct a comprehensive analysis of the pathobiological characteristics of the tumours in an attempt to determine any particular trend that could be present. Methods One hundred and sixty-six cases were included in this study. All the pathology reports and paraffin blocks pertaining to these cases were collected. Four micrometer sections were taken from each block, and immunostaining against Her-2, ER, and PgR was performed. Both the proportion and intensity of immunostaining were scored according to the Allreds method, and typing of the tumour was done according the WHO criteria regarding tumour classification. Grading of invasive carcinomas was done according to the modified Bloom-Richardson-Elstons method, and tumour stage was determined according to the criteria set by the American Joint Committee on Cancer. Results The mean age of the patients below 55 years was 40, as compared to 68 for those above 55 (p < 0.0001). More than half of the cases were in the right breast, and were surgically treated by total mastectomy with axillary clearance. The majority of the tumours had irregular (stellate) margins, was invasive, and had a surrounding breast tissue of adenosis or fibrocystic type. Their mitotic index was 10–20 or >20 with a marked to moderate nuclear pleomorphism. They were mostly grade II or III, sized 2–5 or > 5 cm, had absent or scanty tumour lymphocytes, and were stage II or III. The in situ tumours were mainly ductal carcinoma (DCIS) of which comedo and cribriform were the major histological subtypes. The major histological subtypes of the invasive tumours were ductal-not otherwise specified, lobular, and tubular/cribriform. In this study, we also found a significant (p < 0.05) association between over expression of Her-2, lack of expression of ER and some of the characteristics mentioned above. Conclusion Breast cancer in Kuwait seems to be more aggressive than what is currently seen in Europe, North America, Australia, and parts of Asia. Further investigations regarding the features observed in this study need to be performed.

Protective effects of green tea on intestinal ischemia–reperfusion injury

OBJECTIVE The intestinal mucosa is known to be adversely affected by ischemia-reperfusion (I/R). Previously we showed that green tea protects the intestinal mucosa from fasting-induced damage. The aim of this study is to determine whether green tea has any protective role in I/R of the intestine. METHODS Three groups of male rats were used in this study. Group I (I/R) underwent I/R of the intestine (30 min of ischemia followed by 1 h of reperfusion). Group II (green tea + I/R) was given green tea for 2 wk before inducing I/R. Group III (control) had sham I/R. After the experiments, the jejunum was removed and the tissues were processed for histopathologic examination and immunohistochemical analysis for cell proliferation markers and antioxidant enzymes. RESULTS The intestinal mucosa in group II was preserved compared with that in group I. The expressions of cellular proliferation markers (proliferating cell nuclear antigen and Ki-67) and cellular antioxidants (superoxide dismutase and catalase) in group II were similar to those in group III and much less than in group I, reflecting the protective effects of green tea in group II animals. CONCLUSION In this animal model, administration of green tea before inducing I/R protects the intestinal mucosa from injury.

Fasting‐induced intestinal damage is mediated by oxidative and inflammatory responses

Green tea has been shown to repair fasting‐induced mucosal damage in rat intestine. The aim of this study was to elucidate the underlying mechanism.

Serum anti-modified citrullinated vimentin antibody concentration is associated with liver fibrosis in patients with chronic hepatitis

Background and aims The hepatic stellate cell, which plays a pivotal role in hepatic fibrosis, contains the filament vimentin which is known to undergo protein citrullination and become immunogenic. The aims of this study were to find out if anti-modified citrullinated vimentin (anti-MCV) antibodies are produced in patients with chronic hepatitis and if such production is associated with liver fibrosis. Methods Sera and liver biopsy specimens were collected from 100 patients with chronic hepatitis. Sera were also collected from 100 healthy controls. The liver biopsies were graded according to the Metavir fibrosis scores. The serum concentrations of anti-MCV antibody were measured in both patients and controls by ELISA using commercially available kits. Results The mean serum concentration of anti-MCV antibody in patients with chronic hepatitis (54.90 ± 6.09 U/mL) was significantly higher (P = 0.001) than that of controls (17.38 ± 0.56 U/mL). Furthermore, serum anti-MCV antibody titer was able to separate patients with no fibrosis from those with moderate or severe fibrosis or cirrhosis. Using receiver operating characteristic curves, a serum concentration of anti-MCV antibody of 8.82 U/mL was able to diagnose cirrhosis with 60% specificity and 60% sensitivity. Conclusion We concluded that serum anti-MCV antibody concentration may be a sensitive noninvasive marker for liver cirrhosis that needs to be investigated further.

Spindle cell lipoma: an uncommon tumour with distinctive morphology

Dear Editor, Spindle cell lipoma (SCL) is a relatively uncommon benign neoplasm arising in the subcutaneous tissue of the shoulder and at the back of the neck of older male patients. It represents approximately 1.5% of lipomatous tumours. It is characterized by a mixture of mature fat, bland spindle cells and wiry collagen in a variably myxoid background. There are a few reports of aspiration cytology findings of these tumours in the literature. A cytomorphological appraisal of the tumour is presented. A 45-year-old man presented with a painless, welldefined soft tissue swelling (2 · 2 cm) on the right side of the nape of the neck. The patient stated that the lesion had been present for more than 6 months. The swelling was clinically thought to be an enlarged lymph node or a lipoma. No other masses were noted and the past medical history was otherwise unremarkable. Fine needle aspiration was performed using a 23-gauge needle and a 10-ml syringe fitted onto a Cameco holder. Both alcohol-fixed Papanicolaou and air-dried May-Grünwald–Geimsa-stained slides were prepared. Smears from the aspirated material were cellular. Spindle-shaped cells were seen scattered singly or in aggregates with mature adipose tissue and collagen in varying proportions (Figures 1 and 2). The spindle cells had pale and poorly defined cytoplasm. The nuclei were ovoid or fusiform, basophilic with mild anisonucleosis. Some myxoid material was identified in the aspirate (Figure 2d). Nuclear grooves with intranuclear cytoplasmic inclusions were seen in many nuclei (Figure 1). A few mast cells and ropy, wiry collagen was identified (Figure 2). The cytological diagnosis was that of a benign spindle cell lesion – most likely an SCL. The surgical specimen consisted of a circumscribed piece of adipose tissue measuring 2.2 · 2 · 1.5 cm. Microscopic examination revealed mature adipose tissue and collagen bundles with a proliferation of spindle-shaped cells. The spindle cells were set in a loose stromal matrix and showed minimal pleomorphism (Figure 3). Immunohistochemical examination of the specimen showed clearly positive CD34 and bcl2 (Figure 4) staining in the spindle cell component. SCL was first described by Enzinger and Harvey in 1975 with the aim of distinguishing it from myxoid lipoma/liposarcoma, a frequent misdiagnosis. SCL is a slow-growing benign tumour seen in men between the age of 45 and 70 years. This subcutaneous tumour is frequently located in the neck and upper back. However, unusual locations such as parotid, breast and orbit have also been reported. Cytological findings of SCL are fairly characteristic. The potential clues to diagnosis of SCL include bland spindle cells with only mild nuclear atypia, mature fat, myxoid background, wiry collagen and mast cells. This together with a typical clinical presentation allows a correct diagnosis even on fine needle aspiration. Differential diagnoses for the cytological findings include neurogenic tumours, dermatofibro-

Peptidyl arginine deiminase: A novel immunohistochemical marker for liver fibrosis in patients with chronic hepatitis

Peptidylarginine deiminase (PAD) is an enzyme known to be involved in the pathogenesis of rheumatoid arthritis (RA). Since many of the molecular events present in the joints in RA also take place in the injured liver, we postulated in this study that PAD may be involved in liver fibrosis. The objectives of this study therefore were to find out if PAD could be demonstrated immunohistochemically in liver biopsies of patients with chronic hepatitis and if it is associated with METAVIR activity and fibrosis scores. Liver biopsies were obtained from 100 patients with chronic liver diseases between September 2006 and 2007. The biopsies were scored by two histopathologists according to the METAVIR activity and fibrosis scores after histological preparation. Immunohistochemistry for PAD was performed on the biopsies using a monoclonal antibody against PAD. PAD could not be demonstrated in normal liver biopsies but was found in the hepatocytes of patients with chronic hepatitis. PAD labeling could distinguish patients with no fibrosis from either F1 or F2 or F3 or F4 fibrosis. Similarly, PAD labeling could separate patients with no inflammatory activity from those with mild or moderate or severe activity. We concluded that PAD could be demonstrated immunohistochemically in liver biopsies of patients with chronic hepatitis and that its immunodetection was significantly associated with Metavir activity and fibrosis scores.

The predictive value of CD38 positive hepatic stellate cell count for assessing disease activity and fibrosis in patients with chronic hepatitis.

The activation of hepatic stellate cells (HSCs) is a critical event in hepatic fibrosis. The objectives of this study were to find out if cluster of differentiation 38 (CD38) can be demonstrated immunohistochemically on HSCs in liver biopsies from patients with chronic liver disease and if CD38 immunopositive HSC count is correlated with METAVIR inflammatory and fibrosis scores. Immunohistochemical labelling for CD38 was performed on 100 liver biopsies from patients with chronic liver disease. The CD38 immunopositive HSCs were identified and counted. The CD38 immunopositive HSC count was found to be associated with both the METAVIR score and the fibrosis scores. The CD38 immunopositive HSC count was able to discriminate between no fibrosis and stages 2, 3 or 4 fibrosis, but could not discriminate between no fibrosis and stage 1 fibrosis. Using receiver operating characteristic (ROC) curves, a cut-off point of 10 HSCs per 10 high power field (hpf), or 25 per 100 hepatocytes, is 80% sensitive and 70% specific for predicting fibrosis. The specificity rose to 100% in patients with hepatitis C viral (HCV) infection. We conclude that CD38 positive HSCs can be demonstrated immunohistochemically and that the count is highly predictive of moderate to severe hepatic fibrosis.