Shiraz Emedical Journal
Volume:7 Issue: 1, Jan 2006

Alkaline phosphatase (ALP; EC 3.1.3.1) is mainly derived from the liver, bones and in lesser amounts from intestines, placenta, kidneys and leukocytes. A raised level of alkaline phosphatase in the blood frequently indicates a variety of diseases. The examination of the ALP isoenzyme can be performed by electrophoresis. This examination can be helpful in disease classification of those cases with hyperalkalinephosphatasemia. Of several ALP isoenzymes, biliary ALP isoenzyme is mentioned for its clinical usefulness in detection of biliary obstruction. Here, the authors performed a study to investigate the clinical usefulness of biliary alkaline phosphatase isoenzyme in biliary obstruction. Of interest, there is no significant difference of serum ALP level between malignant and benign biliary obstruction group. But there is a significant difference of serum biliary - ALP isoenzyme between malignant (range 28 U/L – 365 U/l) and benign biliary obstruction (range 20 – 140 U/L). Nevertheless, the average biliary - ALP level of the cholangiocarcinoma cases (range 105 – 365 U/L) is significant higher than the other malignant biliary obstruction cases (range 28 – 50 U/L). According to our study, the biliary - ALP isoenzyme determination can be use as a marker for malignant biliary obstruction.

Pulmonary pneumonia and tuberculosis are both lower respiratory tract infections that affect almost all class of people mostly in developing countries. Few current and up to date data are available on the trend of the above disease conditions in Ekpoma and its environs. To assess the incidence of Streptococcus pneumoniae infection among patients attending tuberculosis clinics in Ekpoma Nigeria. Alpha hemolytic organisms on chocolate and Blood agar from 330 sputum samples randomly selected from patients attending tuberculosis clinics in Ekpoma, suspected to be Streptococcus pneumoniae were identified using bile solubility and optochin sensitivity test while Mycobacterium tuberculosis were identified by the Ziel Nelson technique for acid and alcohol fast bacilli. Out of the 330 samples examined, 21 (6.4%) and 81 (84.6%) of Streptococcus pneumoniae and Mycobacterium tuberculosis respectively were detected. Out of 144/186 male/female examined, 15 (10.4%), 6 (3.2%), and 48 (33.3%), 33 (17.7%) of Streptococcus pneumoniae and Mycobacterium tuberculosis from male/ female samples respectively. Age group 1-9 years was mostly affected by Streptococcus pneumoniae, age group 50 -59 years which had high incidence of Streptococcus pneumoniae and Mycobacterium tuberculosis respectively. The occupational group identified as ‘others’ which include mostly children, had the highest incidence of both Streptococcus pneumoniae and Mycobacterium tuberculosis followed by farmers.The relevance of accurate and current data on the infection trend of Streptococcus pneumoniae and Mycobacterium tuberculosis respectively can not be over emphasized.

This study was carried out to evaluate the possible protective role of some serum factors like pH and adequate level of calcium, phosphate and fluoride in dental caries. Total of 100 subjects of either sex, aged 10-40 were selected. Decayed, missed and filled teeth (DMFT) were used as indices for scoring the dental caries and were distributed into 4 groups on the basis of DMFT indices as 4-8 (Group I), 9-16 (Group II), 17-24 (Group III) and more than 25 (Group IV), while the control subjects had DMFT index equal to or less than 3. Serum was collected and pH, calcium, phosphate, fluoride and lactic acid were analyzed. Patients of dental caries showed significantly decreased levels of calcium, phosphate, fluoride (P<0.001) and significantly increased level of lactic acid (P<0.001) were observed in groups I, II, III and IV as compared to controls. Among groups prominent significant changes were observed in group IV. This study did not show any significant change in serum pH with the progression of disease. From the findings of present study, it can be concluded that the adequate level of calcium, phosphate and fluoride is responsible for the significant deposition of these minerals in plaque which greatly reduces the developmental caries in the adjacent enamel.

The addition of ribavirin (RIBA) to the standard treatment with interferon (IFN) alpha led to an improvement in sustained virologic response (SVR) from less than 20% with IFN monotherapy to 40-45% in combination therapy. The aim of this study is to assess the therapeutic efficacy and safety of IFN alpha (PDferon) in combination with RIBA on Iranian patients with chronic hepatitis C (CHC). 48 naive patients aged 18 years or more with CHC were enrolled and treated with 3 mega units (MU) IFN α-2b three times a week plus 600-1000 mg RIBA per day for 48 weeks. Follow-up after therapy was 6 months. The efficacy was evident at the end of treatment and at the end of follow-up in terms of sustained normalization of alanine aminotransferase and sustained serum HCV-RNA loss. The rate of sustained biochemical and virologic response were 68.3% and 78%, respectively. 40 patients (83.3%) had at least one not serious complication and 8 patients (16.7%) didn’t have any complication. Any patient didn’t have serious complication. Although we had no control group who used standard IFN, our preliminary finding showed acceptable and promising response rate of PDferon. On the other hand, it seems that adverse events with PDferon are as like as other standard IFNs.

Hyperphosphatemia is the consequent of End-Stage-renal failure. Inadequate control of serum phosphorus results in elevated Ca×P product and resultant soft tissue deposition consist of conjunctival and corneal calcification. In this study we evaluated the relationship of conjunctival and corneal calcification with secondary hyperparathyroidism in hemodialysis patients. This is a descriptive – analytic study was done on 24 hemodialysis patients. We measured serum calcium, phosphorus, alkaline phosphatase, iPTH and conjunctival and corneal calcification by using slip – lamp microscope according to a modification of porters criteria. Total patients were 24. The duration of hemodialysis were 30.7 ± 21.7 months. The results of biochemical values were: Ca: 9.1 ± 0.8 mg/dl, P: 6.5 ± 2.2 mg/dl, ipTH: 488 ± 326 pg/ml, Ca×P: 51.5 ± 16.6 The mean of conjunctival and corneal calcification score was 7.1 ± 4.There were a positive correlation between conjunctival and corneal calcification with duration of hemodialysis (p=0.033, r=0.436), Ca×P product (p=0.007, r=0.538). P(p=0.006, r=548) and ipTH (p=0.028, r=0.449). There were not any correlation between conjunctival and corneal calcification with ages of the patients, serum calcium and alkalin phosphatase. Positive correlation of serum phosphorus, Ca×P product and iPTH with conjunctival and corneal calcification and no significant correlation of corneal and conjunctival calcification with serum calcium means that there is a central role for phosphorus in calcium-phosphorus deposition in soft tissues like cornea and conjunctivae, needs to further attention to phosphorus control in hemodialysis patients.

Fissure in ano is a troubling and painful condition that affects a great majority of the population world over. The nature and anatomy of the fissure in ano is quite clear, and much is known about the various predisposing and contributing factors that lead to initiation and progression of the disease. The preferred method of treating them, one that results in optimal clinical results and the least pain and inconvenience for the patient, however, has been open to debate.This study outlines a brief account of the present scenario of different techniques available for the treatment of chronic anal fissure.Considering all aspects, it can be concluded that medical manipulation of the internal sphincter should be a first-line treatment in anal fissure. When this fails or fissures recur, lateral subcutaneous internal sphincterotomy should be the preferred options for the treatment of chronic fissure in ano. Nevertheless, all the options should be presented to the patient with complete information about the method, cure rates, complications, and recurrence of the disease.